Impact of A Pharmacist-Led Heart Failure Clinic on Guideline-Directed Medical Therapy

Abstract

Introduction ACE-I/ARBs, beta-blockers (BB), and aldosterone antagonists are standard of care for patients with heart failure and reduced ejection fraction (HFrEF). Studies have shown that a pharmacist-managed heart failure (HF) medication titration clinic increases the percentage of patients on optimal doses of ACE-I/ARB and BB. Pharmacists’ role in improving follow-up, increasing access to HF medications, and impacting clinical outcomes is not well described in the literature. Hypothesis Including pharmacists in a HF clinic for management of HFrEF leads to greater achievement of target doses of guideline-directed medical therapy (GDMT) within 3 months of an initial visit. Methods This was a prospective, quasi-experimental study comparing patients with HFrEF seen in a pharmacist-run HF clinic to patients managed by usual care. Patients whose initial visit was between September 2019 and January 2020 were included. The primary endpoint was number of patients who reached target or maximally tolerated doses of GDMT within 3-months of the initial visit. Initial and follow up encounters occurred via face-to-face visits in both groups. Secondary endpoints included number of encounters, medication changes, time to follow-up post-discharge, and number of patients considered for ARNI. Results Thirty-nine patients in the pharmacist group and 35 patients receiving usual care were included. Fifteen of the 39 patients were referred to a pharmacist during hospital admission. Within the pharmacist group, the median time to follow up post-discharge was 15 days (IQR, 10.5 - 21.5) with a pharmacist and 31 days (IQR, 24 - 41) with a cardiologist. Including those lost to follow up, GDMT at target doses was achieved in 23/39 in the pharmacist group versus 4/35 in the usual care group (59% vs 11.4 %; P Conclusions Pharmacist involvement in HFrEF management improves patient care with achievement of GDMT earlier than usual care and more frequent follow-up. Other benefits include HF education, greater consideration for ARNI, and earlier access to a healthcare provider after hospital discharge.