Effectiveness of Rapid Guideline-directed Medical Therapies initiation Strategy at Heart failure Clinic, King narai hospital.

Abstract

This study employed a quasi-experimental, one-group pretest–posttest design to evaluate the effectiveness of a rapid and intensive titration protocol for the treatment of heart failure with reduced ejection fraction (HFrEF) at the Heart Failure Clinic, Phra Narai Maharaj Hospital. The sample comprised 34 patients with heart failure, selected through simple random sampling. The intervention consisted of a rapid and intensive titration guideline implemented in the clinic. Data collection instruments included a personal information questionnaire, physical examination and laboratory record forms, medication titration records based on guideline-directed medical therapy (GDMT), time to achieve target GDMT, records of adverse drug events, and hospital readmission data. Data were analyzed using descriptive statistics and paired t-test.

Results showed that, following the application of the rapid and intensive titration protocol, most participants achieved full implementation of GDMT. The majority reached the maximum tolerated dose (% target dose) within 6–10 weeks across the three main drug groups. No severe adverse drug events were observed during the treatment period. Left ventricular ejection fraction (LVEF) significantly improved from a baseline mean of 23.67 ± 6.81% to 35.20 ± 9.57% after 16 weeks of treatment (p < .005).

The rapid and intensive titration protocol in the heart failure clinic enabled most patients to safely achieve target medication doses, with a low incidence of adverse effects. These findings support the feasibility and effectiveness of adopting this approach in routine clinical practice.