Abstract 120: Effectiveness of a Pharmacist Population Health Intervention for Sacubitril/valsartan in Systolic Heart Failure

Abstract

Purpose: Previous literature demonstrates higher prescribing rates by providers after contact with a pharmaceutical representative or after obtaining drug information from an external source. This study aims to evaluate the effectiveness of an Electronic Health Record (EHR), pharmacist-based, population health intervention on physician prescribing patterns of sacubitril/valsartan in patients at Michigan Medicine General Cardiology clinics. Methods: The institutional review board approved this prospective, cluster-randomized controlled study. Patients seen by providers at the General Cardiology clinics of Michigan Medicine between 3/21/2017 and 6/1/2018 were included. Twenty-seven cardiology providers were clustered based on specialty. Fourteen providers were included in the intervention group while 13 providers were included in the control group. Within each arm, study personnel prospectively screened patients by preliminarily filtering those with a diagnosis of systolic heart failure and a left ventricular ejection fraction (LVEF) of 40% or less. Practice-based guideline criteria were then used to determine final patient eligibility. Intervention notifications were sent by pharmacists to providers using the EHR inbox within two-weeks prior to the clinic visit. The primary endpoint for this study was the proportion of patients prescribed sacubitril/valsartan within three months following the appointment. Baseline demographic data was collected on intervention patients. Additionally, the reasons for ineligibility were collected on all patients. Results: A total of 1559 patients were included (intervention=763, control=796). Fifty-two patients met eligibility criteria for sacubitril/valsartan (intervention=16, control=36). Of eligible patients, two in the intervention group and one in the control group had sacubitril/valsartan initiated (12.5% vs. 2.8%, OR 5.0, 95% CI 0.42-59.7, p=0.22). Of the 14 interventions that were not accepted, there was a common provider and 79% of the messages were ignored. The main reasons for ineligibility were patients not taking a dose of angiotensin converting enzyme (ACE) inhibitor or angiotensin-receptor blocker (ARB) equivalent to enalapril 10 mg twice daily (92.6%) or not currently taking an ACE inhibitor or ARB (5.1%). Conclusion: Few patients met practice-based guideline criteria which reflected a conservative approach to initiating sacubitril/valsartan and limited sacubitril/valsartan initiation. EHR inbox interventions may be limited since most of the messages were ignored. Future research should explore tools to aid in optimizing medication therapy for patients with systolic heart failure which may lead to more successful pharmacist-based, population health interventions for this patient population.