Abstract 11243: A Quality Improvement Project to Optimize the Use of Guideline Directed Medical Therapy in Patients With Heart Failure With Reduced Ejection Fraction in the Primary Care Setting

Abstract

INTRODUCTION The 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure provided clear support for the clinical use of ARNIs, ACEIs or ARBs in addition to evidence-based Beta Blockers (BB) and Aldosterone Antagonists (AA) in HFrEF, also known as Guideline-Directed Medical Therapy (GDMT). Despite the known benefits of GDMT, there still remains a significant gap in the use of GDMT in the ambulatory setting. We present a resident-driven quality improvement project to increase the percentage of patients that are on GDMT at target doses. METHODS We performed a root cause analysis and identified the potential barriers to optimal GDMT in HFrEF patients by use of an anonymous survey completed by clinic residents and attending physicians. We then sequentially introduced QI interventions to optimize GDMT, including provider education, clinical pharmacy referral, and involvement of registered nurses and health coaches to identify HFrEF patients for our patient care huddles. GDMT data was collected on October 1 st , 2021 (baseline) and every 5 weeks until April 4 th , 2022 (intervention data). RESULTS Between October 1, 2021 and April 4, 2022, an average of 86 patients with HFrEF were analyzed from the resident clinic every month. Over the study period, the percentage of patients on any dose of GDMT increased from 73.3 to 77.8% (ARNI/ACEI/ARB); 84.1% to 88.2% (BB); and 45.5% to 50% (AA). The percentage of patients on target doses of GDMT increased from 21.7% to 25.9% (ARNI/ACEI/ARB); 8.7% to 16.2% (BB); and 34.8% to 42.4% (AA). The use of hydralazine/isosorbide in patients not on ARNI/ACEI/ARB improved from 12.5% to 24%. CONCLUSIONS A multi-disciplinary team approach shows a positive correlation in improving utilization of target doses of GDMT for HFrEF in the primary care setting. Significant gaps still remain in the utilization of GDMT, and further research is needed to identify targeted approaches to optimize outpatient medical therapy in the primary care setting.