Abstract 13694: Impact of an Interdisciplinary Heart Failure Clinic on Achieving Guideline-Directed Medical Therapy in the Community

Abstract

Background: Guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF) is underutilized despite proven benefits. Strategies to implement GDMT are needed, especially in the era of sodium-glucose cotransporter-2 inhibitors (SGLT2is). Research Question: What is the impact of embedded interdisciplinary heart failure (HF) clinics on HFrEF GDMT prescribing within community cardiology practices? Goal: Compare GDMT prescribing for HFrEF patients followed in community cardiology practices with or without the added support of embedded interdisciplinary HF clinics. Methods: This retrospective chart review of four community-based cardiology practices in North Carolina identified 2,121 patients ≥ 18 years old with a diagnosis of HFrEF (EF ≤ 40%) who had encounters from January 1 to December 31, 2022. Patients were categorized based on whether their encounters included an HF clinic provider. Patients seen in HF clinic also had access to embedded clinical pharmacists and centralized social work support. Chi square test of independence was used to assess differences between groups. Results: Significantly more patients who attended HF clinic (n=1050) compared to those receiving usual care alone (n=1071) were female (36% vs 30%, p<0.01), African American (39% vs 30%, p<0.01), and had systolic BP < 100 mmHg (12% vs 7%, p<0.01). Mean age (67.8 ± 2.4 years), rates of potassium > 5 mEq/L (10%), and rates of GFR < 30 mL/min/1.73m 2 (12%) were similar between groups. HF clinic patients had significantly higher rates of angiotensin receptor/neprilysin inhibitors (ARNis) (72% vs 46%, p<0.01), ACEi/ARB/ARNis combined (86% vs 77%, p<0.01), SGLT2is (61% vs 20%, p<0.01), and mineralocorticoid receptor antagonists (45% vs 32%, p<0.01) prescribed compared to usual care alone. HF beta blocker prescribing was similar between groups (88% vs 89%, p=NS). Conclusion: Patients receiving care in interdisciplinary HF clinics within community cardiology practices had significantly higher rates of HFrEF GDMT prescribing for 3 of the 4 drug classes. Specialized HF clinics can provide patients additional support and resources to achieve GDMT.