Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, PO Box 38, Al-Khodh, PC-123, Muscat, Sultanate of Oman.
Department of Physiology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman.
Int J Clin Pharm. 2021 Aug;43(4):878-883. doi: 10.1007/s11096-020-01190-2. Epub 2020 Nov 2.
Background Significant gaps exist between guidelines and practice in the management of heart failure, not only in Oman but the Arabian Gulf region in general. Currently, only limited research exists on the use of these guideline-based cardiovascular medications and their corresponding target doses in the region. Objective To evaluate the use of guideline-based cardiovascular medications and their corresponding target doses in heart failure patients with reduced (< 40%) and mid-range (40-49%) ejection fraction in Oman. Setting Cardiology clinics at Sultan Qaboos University Hospital, Muscat, Oman. Methods The study included heart failure patients seen at the clinics between January 2016 and December 2019. The use of angiotensin-converting-enzyme inhibitors (captopril, lisinopril) or angiotensin II receptor blockers (irbesartan, valsartan), β-blockers (bisoprolol, carvedilol) and spironolactone along with their respective target doses were evaluated as per the European, American, and Canadian heart failure guidelines. Analyses were performed using univariate statistics. Main outcome measure The proportion of patients that was prescribed guideline-based heart failure medications along with their target doses as per guidelines. Results The overall mean age of the cohort (N = 249) was 63 ± 15 years and 61% (n = 151) were males. Seventy-one percent (n = 177) of the patients had heart failure with reduced ejection fraction while 29% (n = 72) had heart failure with mid-range ejection fraction. A total of 87% (n = 216), 62% (n = 154) and 39% (n = 96) of the patients were on β-blockers, angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers and spironolactone, respectively. Only 33% (n = 81) of the patients were on the triple guideline-based cardiovascular medication classes concurrently. Patients with reduced ejection fraction were more likely to be prescribed the triple guideline-based cardiovascular medication classes concurrently than those that had heart failure with mid-range ejection fraction (37% vs 22%; p = 0.027). A total of 100% (96/96), 56% (121/216) and 42% (64/153) of the patients were prescribed ≥ 50% of target dose for spironolactone, β-blockers and angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers, respectively. Conclusions The use of guideline-based cardiovascular medications in heart failure patients with reduced and mid-range ejection fraction is low in Oman. They were also largely not optimally dosed at target levels.
在心力衰竭的管理方面，指南与实践之间存在显著差距，不仅在阿曼，而且在整个阿拉伯海湾地区都是如此。目前，关于这些基于指南的心血管药物在该地区的使用及其相应目标剂量的研究非常有限。目的：评估在阿曼射血分数降低（<40%）和中间范围（40-49%）的心力衰竭患者中，基于指南的心血管药物及其相应目标剂量的使用情况。设置：阿曼马斯喀特苏丹卡布斯大学医院心内科诊室。方法：该研究纳入了 2016 年 1 月至 2019 年 12 月期间在诊所就诊的心力衰竭患者。根据欧洲、美国和加拿大心力衰竭指南，评估血管紧张素转换酶抑制剂（卡托普利、赖诺普利）或血管紧张素 II 受体阻滞剂（依贝沙坦、缬沙坦）、β受体阻滞剂（比索洛尔、卡维地洛）和螺内酯的使用情况及其相应的目标剂量。使用单变量统计进行分析。主要观察指标：根据指南规定，开具基于指南的心力衰竭药物及其相应目标剂量的患者比例。结果：该队列的总体平均年龄（N=249）为 63±15 岁，61%（n=151）为男性。71%（n=177）的患者患有射血分数降低的心力衰竭，而 29%（n=72）的患者患有射血分数中间范围的心力衰竭。β受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素 II 受体阻滞剂和螺内酯的使用率分别为 87%（n=216）、62%（n=154）和 39%（n=96）。仅有 33%（n=81）的患者同时使用了三种基于指南的心血管药物类别。与射血分数中间范围的心力衰竭患者相比，射血分数降低的心力衰竭患者更有可能同时使用三种基于指南的心血管药物类别（37%比 22%；p=0.027）。螺内酯、β受体阻滞剂和血管紧张素转换酶抑制剂/血管紧张素 II 受体阻滞剂的目标剂量分别为≥50%的患者比例分别为 100%（96/96）、56%（121/216）和 42%（64/153）。结论：在阿曼，射血分数降低和中间范围的心力衰竭患者使用基于指南的心血管药物的情况很少，而且这些药物的剂量也大多未达到目标水平。
