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Impact of Pharmacist-Led Heart Failure Clinic on Optimization of Guideline-Directed Medical Therapy (PHARM-HF)

Tanvi Patil1, Salihah Ali2, Alamdeep Kaur2

  • 1Salem Veterans Affair Medical Center, 1970 Roanoke Blvd., Salem, VA, 24153, USA. tanvipatil@gmail.com.

Journal of Cardiovascular Translational Research
|May 2, 2022
PubMed

Insights

Pharmacist interventions significantly improved guideline-directed medical therapy (GDMT) in heart failure with reduced ejection fraction patients. This led to increased achievement of triple and quadruple GDMT, reducing hospitalizations.

Area of Science:

  • Cardiology
  • Pharmacotherapy
  • Clinical Pharmacy

Background:

  • Heart failure with reduced ejection fraction (HFrEF) requires guideline-directed medical therapy (GDMT) for optimal management.
  • Adherence to complex medication regimens, including triple and quadruple therapy, remains a challenge in HFrEF patients.
  • Pharmacist involvement in medication management can potentially improve therapeutic outcomes.

Purpose of the Study:

  • To evaluate the impact of pharmacist interventions on the achievement of GDMT in HFrEF patients.
  • To compare the proportion of patients achieving triple and quadruple GDMT at 90 days post-enrollment versus baseline.
  • To assess the effect of pharmacist interventions on HF-related hospitalizations and ER visits.

Main Methods:

  • Prospective study including 80 HFrEF patients (< = 40% LVEF) managed in a heart failure medication titration clinic.
  • Primary outcome: proportion of patients achieving triple GDMT (ACEI/ARB/ARNI, beta-blockers, AA) and quadruple GDMT (including SGLT2i) at 90 days compared to baseline.
  • Secondary outcomes: achievement of individual GDMT components and HF-related hospitalizations/ER visits pre- and post-enrollment.

Main Results:

  • Significant improvements were observed in the proportion of patients achieving quadruple GDMT (p = 0.001) and triple GDMT (p = 0.020) at 90 days.
  • Secondary GDMT outcomes also showed significant increases at 90 days post-enrollment.
  • A significant reduction in combined HF-related hospitalizations/ER visits was noted at 90 days pre- vs. post-enrollment (p = 0.047).

Conclusions:

  • Pharmacist interventions are effective in increasing the proportion of HFrEF patients achieving GDMT.
  • These interventions contribute to better adherence to guideline-recommended therapies, including triple and quadruple regimens.
  • Pharmacist-led care may lead to a reduction in healthcare utilization, such as hospitalizations and ER visits, for HFrEF patients.

Keywords:
ACE inhibitorAldosterone antagonistB-adrenergic blockersCongestive heart failureGuideline-directed medical therapy (GDMT)KCCQ-12Medication therapy managementPharmacistsSodium glucose co-transporter 2 inhibitorVeterans

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