Abstract 18106: Keeping up With the Newest Guideline Directed Medical Therapy for Heart Failure With Reduced Ejection Fraction, Resident-Driven Quality Improvement Project

Abstract

Introduction: Chronic Heart Failure (CHF) is an epidemic associated with high morbidity and mortality. As per 2022 AHA/ACC/HFSA guidelines, the management of Heart Failure with reduced Ejection Fraction (HFrEF) includes Angiotensin Receptor-Neprilysin Inhibitors (ARNIs), Angiotensin-Converting Enzyme Inhibitors (ACEIs)/Angiotensin Receptor Blockers (ARBs), Beta-Blockers (BB), Mineralocorticoid Receptor Antagonists (MRA) and Sodium-Glucose co-transporter 2 Inhibitors (SGLT2I) as class 1 recommendations. Considering the new guidelines for HFrEF we decided to perform a quality improvement project to improve the GDMT prescription rate in patients with HFrEF. Methods: Our project included: dot phrase creation for all physicians through electronic medical records (EMR) system, educational sessions, monthly emails and weekly EMR chat messages regarding GDMT and CHF order set to physicians, A4 sized posters distributed on all hospital floors. We then performed retrospective review and analysis of patient charts who were admitted to three UPMC Central PA hospitals with diagnosis of HFrEF exacerbation during December 2019 to January 2021 (pre-intervention) and March 2022 to September 2022 (post-intervention). Results: Total 615 patients were included. There were no significant differences in demographics between pre intervention (357) and post intervention (258) groups including age, sex, race. There were no differences in prescription rate and target dose at discharge between BB groups (92.72% vs 91.86%%, p=0.693 and 7.25% vs 7.17%, p=0.978). The intervention helped in increasing prescription of ARNIs from 6.2% to 30.62%, p< 0.0001 and 13.92% were discharged on target dosages. The prescription of MRA was increased (47.62%vs 51.55%). Furthermore, initiation of SGLT2I was achieved in 41.47% in post-intervention from 0% in the pre-intervention group. Conclusions: Despite higher awareness of GDMT and the trend towards having more patients discharged on therapeutic dosages of GDMT, it is evident that GDMT is still underused among patients with HFrEF. Our results indicate that more emphasis should be placed on rapid up-titration of GDMT.