Evaluating the implementation of guideline-directed medical therapy in the treatment of chronic heart failure at public hospitals in Ethiopia

Background: Guideline-directed medical therapy (GDMT) prolongs survival in patients with heart failure with reduced ejection fraction (HFrEF). However, different countries implement GDMT differently, and many patients are still undertreated. Therefore, this study aimed to assess GDMT utilization in patients with chronic HFrEF at the adult cardiac clinics of three selected hospitals in Addis Ababa, Ethiopia. Methods: An explanatory sequential mixed-methods (quantitative cross-sectional followed by qualitative phenomenological) study design was used to assess GDMT usage in patients with HFrEF at the study settings from September 25 to November 25, 2022. Simple random and purposive sampling techniques were used to select participants for the quantitative and qualitative studies, respectively. Adherence level was defined as good (adherence score = 1), moderate (0.5 < score