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Outcomes of a Pharmacist-Managed Heart Failure Medication Titration Assistance Clinic
Shubha Bhat1, Mayank Kansal2, George T Kondos2
11 Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
Insights
A pharmacist-managed clinic improved optimal medication doses for heart failure with reduced ejection fraction (HFrEF) patients. This approach increased the proportion of patients achieving target doses of ACE inhibitors/ARBs and beta-blockers.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Pharmacy
Background:
- National guidelines advocate for angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) and beta-blockers (BBs) at target doses for heart failure with reduced ejection fraction (HFrEF) to improve outcomes.
- However, suboptimal titration of these essential therapies remains a challenge in clinical practice.
- An outpatient pharmacist-managed HFrEF medication titration assistance clinic (MTAC) was established to address this gap.
Purpose of the Study:
- To evaluate the impact of the MTAC on medication titration.
- To determine the proportion of patients achieving target or maximum tolerated doses of ACE inhibitors/ARBs and BBs.
Main Methods:
- A retrospective chart review was conducted on adult patients with ejection fraction ≤40% between 2011 and 2013.
- Patients were managed either in the MTAC or general cardiology (GC) clinics.
- Medication regimens were collected at baseline and at 1, 2, 3, 6, 9, and 12 months to assess titration progress.
Main Results:
- At baseline, 4% of MTAC patients and 32% of GC patients were on target or maximum tolerated doses of ACE inhibitors/ARBs and BBs.
- After 12 months, 64% of MTAC patients achieved target or maximum tolerated doses compared to 40% of GC patients (P=0.01).
- The proportion of patients prescribed these key HFrEF medications increased in both groups, but significantly more MTAC patients reached optimal dosing.
Conclusions:
- The pharmacist-managed MTAC significantly increased the proportion of patients achieving optimal dosing of recommended HFrEF therapies.
- MTAC serves as a valuable resource for general cardiology patients, enhancing the effectiveness of heart failure management.
- This model demonstrates the critical role of clinical pharmacists in optimizing guideline-directed medical therapy for HFrEF.
Background:
National guidelines recommend angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) and β-blockers (BBs) at target doses for morbidity and mortality benefits in heart failure with reduced ejection fraction (HFrEF); regardless, titration of these therapies in practice remains suboptimal. We implemented an outpatient pharmacist-managed HFrEF medication titration assistance clinic (MTAC) at one institution to improve titration for general cardiology (GC) patients.
Objective:
To evaluate MTAC impact by determining the proportion of patients on target or maximum tolerated ACE inhibitor/ARB and BB doses.
Methods:
A retrospective chart review of adult patients with documented ejection fraction ≤40% managed in the MTAC or GC from 2011 to 2013 was conducted. HFrEF medication regimens were collected at initial visit and months 1, 2, 3, 6, 9, and 12 to assess titration. Target doses were defined per guideline or dose at which ejection fraction recovered during the study. Maximum tolerated doses were defined as the highest dose patients tolerated without physiological limitations.
Results:
Of 148 patients, the MTAC managed 51 and GC managed 97. At baseline, 90% of MTAC versus 82% of GC patients were prescribed ACE inhibitors/ARBs and BBs. In the MTAC, 4% were at target or maximum tolerated doses compared with 32% of GC patients ( P < 0.001). At 12 months, 95% of patients in the MTAC and 87% in GC were prescribed ACE inhibitors/ARBs and BBs. Of those prescribed ACE inhibitors/ARBs and BBs, 64% in the MTAC versus 40% in GC reached target or maximum tolerated doses ( P = 0.01).
Conclusions:
The pharmacist-managed MTAC increased the proportion of patients on optimal HFrEF therapies and are a resource for GC patients.
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