Prescribing pattern, appropriateness, and factors influencing medication use in heart failure patients with reduced ejection fraction at a private tertiary hospital in Malaysia

Pharmacy Practice

  • Wai Kit Soohg1M.Pharm, Student, Department of Pharmacy Practice, School of Pharmacy, IMU University, Kuala Lumpur 57000, Malaysia.
  • Pei Se Wong2BSc Pharmacy, MSc ClinPharm, PhD, Professor, Department of Pharmacy Practice, School of Pharmacy, IMU University, Kuala Lumpur 57000, Malaysia.
  • Pravinkumar Vishwanath Ingle3M.Pharm, PhD, Senior Lecturer, Department of Pharmacy Practice, School of Pharmacy, IMU University, Kuala Lumpur 57000, Malaysia.
  • Priya Manirajan4M.Pharm, Lecturer, Department of Pharmacy Practice, School of Pharmacy, IMU University, Kuala Lumpur 57000, Malaysia.
  • Palanisamy Sivanandy3M.Pharm, PhD, Senior Lecturer, Department of Pharmacy Practice, School of Pharmacy, IMU University, Kuala Lumpur 57000, Malaysia.

Volume 24 Issue 1 Pages 1-13

DOI: 10.18549/PharmPract.2026.1.3457

Abstract

Background: Heart Failure with Reduced Ejection Fraction (HFrEF) is a prevalent and serious medical condition worldwide. It affects millions of people and contributes significantly to morbidity and mortality. Inappropriate use of the medications may lead to adverse health outcomes and treatment failure. Objectives: This study aimed to assess prescribing patterns, the prevalence of potentially inappropriate medications (PIMs), the proportion of patients receiving the target guideline-directed medical therapy (GDMT) dose, and factors associated with suboptimal dosing in patients with HFrEF at a private tertiary care hospital in Malaysia. Methodology: This retrospective observational study involved 118 Malaysian adult patients with HFrEF who attended at least two outpatient cardiology appointments at the study hospital. The study reviewed prescriptions to identify drug prescribing patterns, GDMT use, target dose attainment, and prescribing of PIM. Results: The cohort was primarily comprised of Chinese individuals (84.80%) and males (78.80%), with a mean age of 58.7 years. The majority of patients (51.70%) received a combination of three GDMT drugs. Only 23.70% of patients were prescribed all four GDMT drugs, with 82.14% of these patients achieving at least one drug at the target dose. The prescribing rates of Renin-Angiotensin-Aldosterone System (RAAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and Sodium-Glucose Cotransporter-2 (SGLT-2) inhibitors were 98.31%, 72.97%, 48.31%, and 78.81%, respectively. The attainment of target doses was low, with only 11.21% reaching the target for RAAS inhibitors, 2.32% for beta-blockers, and 1.89% for MRAs. The study indicated no significant association between target dose attainment and clinical factors, except for beta- blockers in atrial fibrillation and SGLT-2 inhibitors in diabetes mellitus. Additionally, 4.24% of patients were prescribed PIM. Conclusion: Both adequate prescribing rates and target dose attainment of GDMT remain challenging in clinical practice, underscoring the need for strategies to improve adherence and enhance patient outcomes.

Keywords

  • Adherence
  • ejection fraction
  • heart failure
  • inappropriate medication
  • medical therapy
  • target dose
Pharmacy Practice

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