Abstract 393: Addressing The Gap In Outpatient Guideline Directed Medical Therapy Dosing In Heart Failure With Reduced Ejection Fraction: Preliminary Findings

Abstract

Background: The benefit of guideline directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF) is well established in the medical literature and clinical practice guidelines. The low prevalence of optimal dosing of these medications remains an obstacle in providing quality care for this patient population. Methods: An electronic medical record (EMR) triggered alert was attached to all patient charts with ICD-10 codes associated with HFrEF at a single internal medicine residency-associated outpatient primary care office. This alert urged use of a GDMT initiation and titration reference sheet based on the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction . A retrospective review of patients with corresponding ICD-10 codes and documented ejection fractions less than or equal to 40% was conducted and the intensity of GDMT dosing in these patients was recorded. A group of patients treated 3 years prior to the intervention were then compared to those treated after the intervention Results: 38 patients with a documented diagnosis of HFrEF that were evaluated between January 9, 2017 and January 9, 2020 were identified. 32 (84.2%) of these patients were on GDMT beta blockers and only 1 (3.1%) of these patients were receiving the target dose. Of the 31 (81.5%) of patients receiving ACE/ARB/ARNi therapy, 9 (41.9%) patients received target dosing. Mineralocorticoid receptor antagonist therapy (MRA) was prescribed to 11 (28.9%) patients; all of these patients received the target dose. Uptitration of medication was observed in the management of 9 (23.7%) of patients. Following the intervention, 8 patients with a documented diagnosis of HFrEF were evaluated between January 9, 2020 and March 5, 2020.GDMT beta blockers were prescribed to 7 (87.5%) of these patients; 1 (12.5%) patient received a target dose. ACE/ARB/ARNi therapy was given to all 8 patients and half of the patients were prescribed a target dose. MRA treatment was given to 2 (25%) of the8 patients; both patients were given the target dose. Uptitration of GDMT was observed in 1 (12.5%) patient following the intervention. There was no statistically significant difference between pre-intervention and post-intervention groups (P= 0.7187) regarding initiation and uptitration of GDMT. Conclusion: An EMR triggered effort to improve GDMT dosing in HFrEF patients did not show significant improvement in a small patient population over a short time period.