Guideline-Directed Medical Therapy in the Management of Cardiovascular Disease: A Cross-sectional Questionnaire-based Study amongst Indian Healthcare Professionals
Introduction: Guideline-Directed Medical Therapies (GDMT) are evidence-based treatments recommended by clinical practice guidelines for the management of Cardiovascular Diseases (CVDs). While GDMT is foundational for treating Heart Failure (HF), its adoption promotes uniform, evidence-driven practic...
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JCDR Research and Publications Private Limited
2025-04-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://jcdr.net/articles/PDF/20818/74786_CE[Ra1]__F(SHU)_QC(PS_IS)_PF1(AG_SS)_PFA(IS)_PB(AG_IS)_PN(IS).pdf |
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| author | Prafulla Kerkar Rajeev Garg Abhishek Shukla Viveka Kumar Akshyaya Pradhan Arindam Pande Johan Christopher Febin Francis Nitin Zalte Amarnath Sugumaran |
| author_facet | Prafulla Kerkar Rajeev Garg Abhishek Shukla Viveka Kumar Akshyaya Pradhan Arindam Pande Johan Christopher Febin Francis Nitin Zalte Amarnath Sugumaran |
| author_sort | Prafulla Kerkar |
| collection | DOAJ |
| description | Introduction: Guideline-Directed Medical Therapies (GDMT) are evidence-based treatments recommended by clinical practice guidelines for the management of Cardiovascular Diseases (CVDs). While GDMT is foundational for treating Heart Failure (HF), its adoption promotes uniform, evidence-driven practices across various cardiovascular conditions. This therapy includes drug classes such as Beta-Blockers (BB), Angiotensin-Converting Enzyme inhibitors, Angiotensin-Receptor Blockers, and Angiotensin Receptor-Neprilysin Inhibitors (ACEi/ARB/ARNI), Mineralocorticoid Receptor Antagonists (MRAs), and Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2i). Implementing GDMT can enhance cardiac function, improve quality of life and reduce hospitalisation and mortality risks.
Aim: To understand the preferences of drug choice among Indian Healthcare Practitioners (HCPs) regarding the adaptation of GDMT in CVD management.
Materials and Methods: A cross-sectional, questionnaire-based study was conducted in India from December 2022 to March 2023. Participants (n=93) included cardiologists, electrophysiologists and cardiophysicians, who were actively involved in managing CVD. A predefined questionnaire consisting of seven questions, developed from existing literature, guidelines and expert opinions, was used. Responses were digitally analysed, with descriptive statistics presented as numbers and percentages.
Results: For hypertension management in Acute Coronary Syndrome (ACS), telmisartan (60.22%) was the most preferred ARB, followed by metoprolol (48.39%; BB), amlodipine (39.78%; Calcium Channel Blockers [CCB]), and torsemide (32.26%; diuretics). For patients with diabetes and ACS, SGLT2i (89.29%) were favoured. Clopidogrel (56.99%) was the preferred oral antiplatelet drug alongside aspirin in ACS. In Acute Decompensated HF (ADHF), the preferred sequential addition of GDMT includes loop diuretics (44.74%) as the first choice, followed by ARB, SGLT2i, and MRAs as subsequent choices. One in four HF patients was on ARNI (37.36%) and SGLT2i (35.62%), while three in four HF patients were on BB (36.99%) and ACEi/ARBs (34.28%). In HF patients on loop diuretics and MRAs, the preferred doses were torsemide 10 mg with spironolactone 25 mg (57.32%) and torsemide 10 mg with spironolactone 50 mg (37.80%). In addition to symptomatic treatment with loop diuretics in HF patients, 72.50% of HCPs preferred ARNI, and 35.0% preferred ARBs as combination therapy.
Conclusion: ARBs and BBs were preferred for hypertension in ACS, while SGLT2i were favoured for diabetes. Clopidogrel was the most popular P2Y12 inhibitor in ACS. For HF, HCPs favoured sequential therapy, with loop diuretics and ACEi/ARBs as the first and second choices and preferred combinations of ARNI or ARBs with loop diuretics for symptomatic HF. |
| format | Article |
| id | doaj-art-ae463769ba754193be56a1ef16db3039 |
| institution | DOAJ |
| issn | 2249-782X 0973-709X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj-art-ae463769ba754193be56a1ef16db30392025-08-20T03:06:09ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2025-04-01194061110.7860/JCDR/2025/74786.20818Guideline-Directed Medical Therapy in the Management of Cardiovascular Disease: A Cross-sectional Questionnaire-based Study amongst Indian Healthcare ProfessionalsPrafulla Kerkar0Rajeev Garg1Abhishek Shukla2Viveka Kumar3Akshyaya Pradhan4Arindam Pande5Johan Christopher6Febin Francis7Nitin Zalte8Amarnath Sugumaran9Consultant Cardiologist, Department of Cardiology, Asian Heart Institute, Mumbai, Maharashtra, India.Senior Interventional Cardiologist and Head, Department of Cardiology, Aware Gleneagles Global Hospitals, Hyderabad, Telangana, India.Consultant Cardiologist, Department of Cardiology, Pulse Heart Centre, Lucknow, Uttar Pradesh, India.Consulting Cardiologist, Department of Cardiology, Max Super Specialty Hospital, New Delhi, India.Professor, Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India.Consultant Interventional Cardiologist, Medica Super Specialty Hospital, Kolkata, India.Consultant Cardiologist, Department of Cardiology, Care Hospital, Hyderabad, Telangana, India.Medical Affairs, Cipla Ltd., Mumbai, Maharashtra, India.Medical Affairs, Cipla Ltd., Mumbai, Maharashtra, India.Medical Affairs, Cipla Ltd., Mumbai, Maharashtra, India.Introduction: Guideline-Directed Medical Therapies (GDMT) are evidence-based treatments recommended by clinical practice guidelines for the management of Cardiovascular Diseases (CVDs). While GDMT is foundational for treating Heart Failure (HF), its adoption promotes uniform, evidence-driven practices across various cardiovascular conditions. This therapy includes drug classes such as Beta-Blockers (BB), Angiotensin-Converting Enzyme inhibitors, Angiotensin-Receptor Blockers, and Angiotensin Receptor-Neprilysin Inhibitors (ACEi/ARB/ARNI), Mineralocorticoid Receptor Antagonists (MRAs), and Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2i). Implementing GDMT can enhance cardiac function, improve quality of life and reduce hospitalisation and mortality risks. Aim: To understand the preferences of drug choice among Indian Healthcare Practitioners (HCPs) regarding the adaptation of GDMT in CVD management. Materials and Methods: A cross-sectional, questionnaire-based study was conducted in India from December 2022 to March 2023. Participants (n=93) included cardiologists, electrophysiologists and cardiophysicians, who were actively involved in managing CVD. A predefined questionnaire consisting of seven questions, developed from existing literature, guidelines and expert opinions, was used. Responses were digitally analysed, with descriptive statistics presented as numbers and percentages. Results: For hypertension management in Acute Coronary Syndrome (ACS), telmisartan (60.22%) was the most preferred ARB, followed by metoprolol (48.39%; BB), amlodipine (39.78%; Calcium Channel Blockers [CCB]), and torsemide (32.26%; diuretics). For patients with diabetes and ACS, SGLT2i (89.29%) were favoured. Clopidogrel (56.99%) was the preferred oral antiplatelet drug alongside aspirin in ACS. In Acute Decompensated HF (ADHF), the preferred sequential addition of GDMT includes loop diuretics (44.74%) as the first choice, followed by ARB, SGLT2i, and MRAs as subsequent choices. One in four HF patients was on ARNI (37.36%) and SGLT2i (35.62%), while three in four HF patients were on BB (36.99%) and ACEi/ARBs (34.28%). In HF patients on loop diuretics and MRAs, the preferred doses were torsemide 10 mg with spironolactone 25 mg (57.32%) and torsemide 10 mg with spironolactone 50 mg (37.80%). In addition to symptomatic treatment with loop diuretics in HF patients, 72.50% of HCPs preferred ARNI, and 35.0% preferred ARBs as combination therapy. Conclusion: ARBs and BBs were preferred for hypertension in ACS, while SGLT2i were favoured for diabetes. Clopidogrel was the most popular P2Y12 inhibitor in ACS. For HF, HCPs favoured sequential therapy, with loop diuretics and ACEi/ARBs as the first and second choices and preferred combinations of ARNI or ARBs with loop diuretics for symptomatic HF.https://jcdr.net/articles/PDF/20818/74786_CE[Ra1]__F(SHU)_QC(PS_IS)_PF1(AG_SS)_PFA(IS)_PB(AG_IS)_PN(IS).pdfacute coronary syndromeanticoagulantantiplateletbeta-blockersheart failurehypertension |
| spellingShingle | Prafulla Kerkar Rajeev Garg Abhishek Shukla Viveka Kumar Akshyaya Pradhan Arindam Pande Johan Christopher Febin Francis Nitin Zalte Amarnath Sugumaran Guideline-Directed Medical Therapy in the Management of Cardiovascular Disease: A Cross-sectional Questionnaire-based Study amongst Indian Healthcare Professionals Journal of Clinical and Diagnostic Research acute coronary syndrome anticoagulant antiplatelet beta-blockers heart failure hypertension |
| title | Guideline-Directed Medical Therapy in the Management of Cardiovascular Disease: A Cross-sectional Questionnaire-based Study amongst Indian Healthcare Professionals |
| title_full | Guideline-Directed Medical Therapy in the Management of Cardiovascular Disease: A Cross-sectional Questionnaire-based Study amongst Indian Healthcare Professionals |
| title_fullStr | Guideline-Directed Medical Therapy in the Management of Cardiovascular Disease: A Cross-sectional Questionnaire-based Study amongst Indian Healthcare Professionals |
| title_full_unstemmed | Guideline-Directed Medical Therapy in the Management of Cardiovascular Disease: A Cross-sectional Questionnaire-based Study amongst Indian Healthcare Professionals |
| title_short | Guideline-Directed Medical Therapy in the Management of Cardiovascular Disease: A Cross-sectional Questionnaire-based Study amongst Indian Healthcare Professionals |
| title_sort | guideline directed medical therapy in the management of cardiovascular disease a cross sectional questionnaire based study amongst indian healthcare professionals |
| topic | acute coronary syndrome anticoagulant antiplatelet beta-blockers heart failure hypertension |
| url | https://jcdr.net/articles/PDF/20818/74786_CE[Ra1]__F(SHU)_QC(PS_IS)_PF1(AG_SS)_PFA(IS)_PB(AG_IS)_PN(IS).pdf |
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