Abstract 14276: Bridging The Gap To Optimal Dosing For Guideline-directed Medical Therapy For Patients With Heart Failure And Reduced Ejection Fraction

Abstract

Introduction: The key to improving heart failure (HF) outcomes and its ultimate impact on reducing health care costs include the initiation, optimization, and maintenance of guideline-directed medical therapy (GDMT) in patients with Heart Failure and Reduced Ejection Fraction (HFrEF). The ACC/AHA/HFSA guidelines recommend maximum tolerated doses for these patients unless contraindicated. Despite widespread knowledge, there is underutilization of GDMT at recommended target doses in eligible patients. Hypothesis: Majority of eligible patients (>50%) in our safety-net HF Clinic are on optimal doses of GDMT. Methods: We conducted a retrospective analysis of GDMT use in patients who were diagnosed with HFrEF between January 1 to March 31, 2019, and completed at least two HF clinic visits in 2019. The primary outcomes were the percent of patients on optimal doses of: (1) beta blockers, (2) renin-angiotensin-aldosterone system (RAAS) inhibitors, and (3) mineralocorticoid antagonists (MRAs). Optimal dose was defined >/= 50% of target dose or maximum tolerated dose. Results: Our cohort of 227 patients was predominantly male (70%), African American (94%) with mean age of 59 +/- 11 years. Most patients were on beta blockers (96%) and RASS inhibitors (88%). Only 11% were on Angiotensin Receptor-Neprilysin Inhibitors(ARNI), and 30% on MRAs. Only 52%, 43%, and 20% of patients were prescribed target doses of beta blockers, ACEI/ARBs, and MRAs respectively. Conclusions: GDMT dosing in our safety-net HF Clinic was suboptimal. Based on these findings, we are implementing a quality improvement process to facilitate early initiation and up-titration of GDMT with the overall goal of reducing the morbidity and mortality in our patient population.