Impact of Pharmacist-Led Heart Failure Clinic on Optimization of Guideline-Directed Medical Therapy (PHARM-HF)

Abstract

This prospective study included patients with heart failure (HF) with reduced ejection fraction (HFrEF) with LVEF < = 40% to evaluate the impact of pharmacist on guideline directed medical therapy (GDMT). The primary outcome was to compare proportion of triple GDMT achieved for Angiotensin-Converting-Enzyme-Inhibitors (ACEI)/Angiotensin-Receptor-Blockers (ARB)/Angiotensin-Receptor-Neprilysin-Inhibitors (ARNI), beta-blockers, aldosterone antagonists (AA), and quadruple GDMT which in additional to triple therapy, included Sodium glucose co-transporter 2 inhibitor (SGLT2i) at 90-day post-enrollment compared to baseline. Secondary endpoints included achieving target and/or maximally tolerated ACEI/ARB/ARNI and beta-blockers combined and individually as well as SGLT2i and AA GDMT at 90-day post-enrollment compared to baseline. We also compared combined and individual HF-related hospitalization/emergency room (ER) visits 90 days pre-/post-enrollment. Of the total 974 patients screened, 80 patients seen at least once in the heart failure medication titration clinic (HMTC) were included in the analysis. Median (IQR) age was 71 (57–69) years with majority white male. There was a significant improvement in the proportion of patients who achieved quadruple GDMT ( p = 0.001) and triple GDMT ( p -value = 0.020) at 90-day post-enrollment compared to baseline. The secondary GDMT outcomes were also significantly increased at 90 days post-enrollment compared to baseline. Significant difference in mean as well as proportion of combined HF-related hospitalization/ER-visits was found 90 days pre-/post-enrollment ( p = 0.047). Our study found that pharmacist’s intervention increased the proportion of patients who achieved GDMT at 90 days. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s12265-022-10262-9.

VA Home Telehealth Program for Initiating and Optimizing Heart Failure Guideline-Directed Medical Therapy

“…These results are similar to those of other trials that demonstrated improved rates of GDMT in the setting of pharmacist-or nurse-led HF treatment optimization. 15,16 These positive results differ from other trials incorporating remote monitoring regarding patient continuation in HT programs. For example, in a study by Ding and colleagues, the withdrawal rate from their monitoring service was about 22%, while in our study only 1 patient withdrew from the HT program.…”

Mortality and Hospitalization Rate of Heart Failure Patients with Preserved Ejection Fraction Treated with Dapagliflozin vs. Empagliflozin

“…The higher initial incidence highlights the importance of close follow-up during the initiation phase of treatments. Pharmacist-led HF clinics may play a role in these scenarios by timely and accurate protocol-driven dose titration, laboratory monitoring and patient education by pharmacists [26][27][28][29][30]. Further research is warranted to determine the optimal approach for managing these patients and improving outcomes.…”

Overcoming the Clinical Inertia behind Inadequate Adherence to Guideline-Directed Medical Therapy

“…Recently, several efforts have been made to improve compliance with GDMT to overcome clinical inertia. Programs led by medical staff, such as nurses and pharmacists, have been shown to have the potential to lead to improved GDMT practices and better outcomes [9,10]. It may be important for medical teams, including other medical staff, to repeatedly review physician's prescriptions to ensure that GDMT compliance is being practiced where applicable.…”