Evaluation of treatment compliance and target dose rates in heart failure

Objective: The aim of the study is to evaluate the compliance of heart failure (HF) patients with lifestyle changes, to determine the target dose usage rate along with the usage rate of drugs recommended by the guidelines, and to investigate the effect of reaching appropriate doses on clinical outcomes. Methods: One hundred fifty-two patients (M:108, F:44, average age: 61.3±13.4) with ejection fraction (EF) ≤ % 40 were included in the study. Demographic data of the patients, examination findings, echocardiography parameters, causes of decompensation, drug use doses, daily fluid and salt intakes were recorded. During the 1-year follow-up of the patients, efforts were made to increase the use of recommended medications and reach the target dose. At the end of follow-up, the effects of compliance with lifestyle changes and target dose medication use on NYHA (New York Heart Association) class, HF-related hospitalization and mortality were examined. Results: The causes of decompensation were myocardial ischemia/infarction, arrhythmia and infection (% 23,9, % 14,8, % 10,2), respectively. The most common examination findings were found to be rales, orthopnea and edema (% 66,4, % 46,7, % 38,8), respectively. Compared to before follow-up, the rate of drug use in patients at the end of follow-up increased significantly in beta blockers (BB) (from % 87,5 to % 98,7), angiotensin converting enzyme inhibitor/angiotensin receptor blockers (ACEi/ARB) (from % 80,9 to % 93,4) and mineralocorticoid receptor antagonists (MRA) (from % 57,9 to % 75). The rate of use of % 50 or more of the target dose also increased in BBs (from % 46 to % 76,3), ACEi/ARBs (from % 51,3 to % 73,7) and MRAs (from % 57,2 to % 75). When all three drug groups were evaluated separately, a decrease in mortality and hospitalizations due to HF was detected in those who used % 50 or more of the target dose, but it did not reach statistical significance. However, when BB and ACEi/ARB were evaluated together and MRA alone, the improvement in NYHA class reached a significant level. Conclusion: It was observed that the rate of use of drugs known to reduce mortality in heart failure and the rate of target dose use were extremely low, and with appropriate guidance and follow-up, these rates could be increased significantly for each drug group. When beta blocker and ACEi/ARB together and MRA were evaluated alone, it was determined that there was a significant improvement in NYHA class of those who reached the target dose. Key words: ACEi/ARB, beta blocker, decompensation, heart failure, lifestyle change