Impact of Adherence to Guideline-Directed Medical Therapy on Clinical Outcomes in Heart Failure: Evidence from a Single-Centre Study in Pakistan

Abstract

Objectives: To evaluate the impact of adherence to Guideline-Directed Medical Therapy (GDMT) on mortality, rehospitalisation, and clinical outcomes among patients with heart failure (HF) in a tertiary care setting in Pakistan. Methodology: A cohort of 250 HF patients was enrolled and categorized into two groups based on their adherence to GDMT. Demographic details, comorbidities, and clinical outcomes were documented. Outcomes including all-cause mortality and rehospitalisation rates were compared between the adherent and non-adherent groups. Statistical analysis was performed using chi-square tests for categorical variables, with a p-value ≤ 0.05 considered statistically significant. Hazard ratios were derived through multivariate analysis. Results: Adherence to GDMT was significantly associated with better clinical outcomes. The mortality rate was 7.2% in the adherent group compared to 14.4% in the non-adherent group (p = 0.05). Rehospitalisation occurred in 14.4% of adherent patients versus 28.8% of non-adherent patients (p = 0.02). Multivariate analysis confirmed that GDMT adherence was independently associated with reduced mortality (HR = 0.45, p = 0.03) and lower rehospitalisation rates (HR = 0.52, p = 0.04). Conclusion: Adherence to GDMT significantly reduces mortality and rehospitalisation in heart failure patients. These findings underscore the urgent need to implement strategies that improve adherence in clinical practice, particularly in low-resource settings like Pakistan.