PROFlL GUIDELINE-DIRECTED MEDICAL THERAPY PADA PASIEN GAGAL JANTUNG KRONIK DENGAN PENURUNAN FRAKSI EJEKSI VENTRIKEL KIRI

Abstract

Background: GDMT comprising ACEI/ARB/ARNI, beta blockers, MRA, and SGLT2 inhibitors has demonstrated significant mortality benefits in HFrEF. Real-world GDMT implementation remains suboptimal, and evidence from Indonesia where national formulary restrictions shape prescribing patterns is absent. Objective: To evaluate real-world GDMT implementation and target dose achievement in HFrEF patients. Methods: A retrospective observational study was conducted at the Cardiology Outpatient Clinic of Universitas Airlangga Hospital, Surabaya, from March to May 2025. Patients with HFrEF (LVEF ≤40%) receiving GDMT for ≥3 months were enrolled. Results: Most patients were male (72.4%), elderly (52.9%), with hypertension as the predominant comorbidity (32.1%). Two-pillar therapy predominated (58.6%), and no patient received four-pillar therapy due to SGLT2 inhibitor unavailability in the National Formulary. Target dose achievement was universally suboptimal: only 10% of ACEI/ARB patients reached 100% target dose, while all ARNI (100%) and 93% of beta blocker patients received less than 50% of target dose. Conclusion: GDMT implementation in HFrEF patients remains suboptimal. Two-pillar therapy predominated (58.6%), with no patient achieving four-pillar coverage. Target dose achievement across all GDMT classes remained below guideline recommendations. National Formularium restrictions, physiological limitations (bradycardia and hypotension), and clinical inertia might be primary barriers. National formulary revision and multidisciplinary approaches are urgently needed to optimize HFrEF outcomes.