Implementation Of A Pharmacist-Driven Medication Optimization Service Improves Heart Failure Medication Doses And Diabetes Metrics

Abstract

<h3>Background</h3> Although titration of guideline-directed heart failure medications (GDMT) to maximum doses improves morbidity and mortality in patients with heart failure with reduction ejection fraction (HFrEF), analysis of real world clinical data indicates that the majority of patients remain on suboptimal regimens. <h3>Hypothesis</h3> : We hypothesize that an outpatient pharmacist driven service utilizing collaborative drug therapy management (CDTM) increases compliance with GDMT and optimization of cardio-protective diabetes medications <h3>Methods</h3> A retrospective chart review was performed on eligible patients seen by the heart failure pharmacist from January 2020 through December 2020 at the Rochester Regional Health Heart Failure Clinic. Data was gathered for patients through March 2021 to allow for at least 3 months of follow up. A total of 117 eligible patients identified for being referred to heart failure pharmacist for HFrEF GDMT titration and/or diabetes management (N=100 in HFrEF analysis; N=64 in diabetes analysis) during the study period. <h3>Results</h3> At 3 months from initial pharmacist visit, mean doses of HFrEF GDMT, expressed as a percentage of target dose, were all increased from baseline. β-blocker doses increased from 41.8% to 54.3% (P<0.001), while RAAS inhibitor doses increased from 40.1% to 55.3% (P<0.001)). Fully optimized GMDT regimens improved from 9 patients (9%) at baseline to 37 patients (37%) (P<0.001), and the percent of HFrEF patients on SGLT2 inhibitors increased from 35% to 54% (P=0.008). Diabetes endpoints also significantly improved, with mean A1c reduction of 0.9% from baseline (8.4% vs 7.5%, P<0.001). The percent of patients with controlled A1c (≤7.0%) on both SGLT2 inhibitor and GLP1 agonist improved from 1.6% to 17.8% of patients (P=0.0044). <h3>Conclusion</h3> This study demonstrates that a physician-pharmacist collaborative drug therapy management (CDTM) model is effective at increasing doses of HFrEF GDMT. Furthermore, pharmacist co-management of GDMT optimization and diabetes optimization is an effective model for improving compliance with guidelines, control of diabetes, and, ultimately, cardiovascular risk through the utilization of appropriate cardio-protective medications.