Impact of Heart Failure Improvement Clinic on Guideline-Directed Medical Therapy Optimization in Adult Patients with Heart Failure with Reduced Ejection Fraction: A Retrospective Study
by Sydney E. Walker, PharmD, Jennifer L. Grimm, PharmD, BCPS, and Tonja L. Larson, PharmD, BCPS, BCACP
Abstract:
Background: Nearly 1 in 4 heart failure patients are re-hospitalized within 30 days of discharge. Continuity of care, with early optimization of guideline-directed medical therapy (GDMT), including a preferred beta-blocker, renin-angiotensin system inhibitor (RASi), mineralocorticoid receptor antagonist (MRA), and sodium-glucose cotransporter-2 inhibitor (SGLT2i), is crucial. However, these therapies remain suboptimal in patients with heart failure with reduced ejection fraction (HFrEF), defined as ejection fraction less than or equal to 40%.
Methods: We aimed to evaluate the impact of our rural health system’s Heart Failure Improvement Clinic (HFIC) on initiation and titration of GDMT in adult patients with newly diagnosed or chronic HFrEF who were hospitalized between April 1, 2022, and December 31, 2022. Primary outcomes were GDMT changes from index hospital discharge to 30 days and 90 days post discharge for HFIC patients and non-HFIC patients.
Results: Among 163 patients, a total of 92 patients (56.4%) were managed by the HFIC during the trial period, and 71 (43.6%) were not managed by the HFIC. No significant difference was found in number of GDMT medications prescribed between HFIC and non-HFIC patients (average diff. 30 days: 0.17 vs. 0.03, p=0.154; 90 days: 0.29 vs 0.14, p=0.266). Regarding GDMT medication titration, HFIC patients had significantly greater improvement in total number of GDMT medications titrated to target dosing at 90 days compared to non-HFIC patients (average diff. 0.25 vs. 0.02, p=0.014).
Conclusions: This study demonstrated that management of HFrEF patients by a specialized heart failure clinic has the potential to improve GDMT dose optimization post-hospitalization.
Keywords: Heart Failure, Heart Failure with Reduced Ejection Fraction, HFrEF, GDMT, rural health
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2024 September/October Table of Contents
Abstract:
Background: Nearly 1 in 4 heart failure patients are re-hospitalized within 30 days of discharge. Continuity of care, with early optimization of guideline-directed medical therapy (GDMT), including a preferred beta-blocker, renin-angiotensin system inhibitor (RASi), mineralocorticoid receptor antagonist (MRA), and sodium-glucose cotransporter-2 inhibitor (SGLT2i), is crucial. However, these therapies remain suboptimal in patients with heart failure with reduced ejection fraction (HFrEF), defined as ejection fraction less than or equal to 40%.
Methods: We aimed to evaluate the impact of our rural health system’s Heart Failure Improvement Clinic (HFIC) on initiation and titration of GDMT in adult patients with newly diagnosed or chronic HFrEF who were hospitalized between April 1, 2022, and December 31, 2022. Primary outcomes were GDMT changes from index hospital discharge to 30 days and 90 days post discharge for HFIC patients and non-HFIC patients.
Results: Among 163 patients, a total of 92 patients (56.4%) were managed by the HFIC during the trial period, and 71 (43.6%) were not managed by the HFIC. No significant difference was found in number of GDMT medications prescribed between HFIC and non-HFIC patients (average diff. 30 days: 0.17 vs. 0.03, p=0.154; 90 days: 0.29 vs 0.14, p=0.266). Regarding GDMT medication titration, HFIC patients had significantly greater improvement in total number of GDMT medications titrated to target dosing at 90 days compared to non-HFIC patients (average diff. 0.25 vs. 0.02, p=0.014).
Conclusions: This study demonstrated that management of HFrEF patients by a specialized heart failure clinic has the potential to improve GDMT dose optimization post-hospitalization.
Keywords: Heart Failure, Heart Failure with Reduced Ejection Fraction, HFrEF, GDMT, rural health
Download PDF
2024 September/October Table of Contents