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Evaluating Guideline Directed Medical Therapy in Patients With Heart Failure With Reduced Ejection Fraction

Galen M Kabulski1, Troy Boughner2, Thomas W Szymanski1

  • 1Department of Pharmacy Services, J.W. Ruby Memorial Hospital, Morgantown, WV, USA.

Journal of Pharmacy Practice
|August 4, 2022
PubMed

Insights

Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) is underutilized in patients undergoing coronary artery bypass grafting (CABG). Post-CABG GDMT prescription rates did not significantly improve, indicating a need for optimized collaborative care.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Pharmacology

Background:

  • Limited data exists on guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) in patients undergoing coronary artery bypass grafting (CABG).
  • Understanding GDMT prescription patterns before and after CABG is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To characterize the prescription patterns of HFrEF GDMT in patients undergoing CABG.
  • To evaluate the use of specific GDMT components, including heart failure beta-blockers (HFBB) and renin-angiotensin inhibitors, and mineralocorticoid receptor antagonists (MRA).

Main Methods:

  • Retrospective analysis of adult patients with ejection fraction ≤40% undergoing CABG.
  • Evaluation of HFrEF GDMT (HFBB and renin-angiotensin inhibitor) use preoperatively and up to 1 year postoperatively.
  • Assessment of individual therapy dosing, prescription rates, and MRA use.

Main Results:

  • Only 52.6% of patients received HFrEF GDMT pre-CABG; rates did not significantly increase post-CABG.
  • Significant increase in the use of renin-angiotensin inhibitors, HFBB, and aldosterone antagonists from 13.2% pre-CABG to 36.8% at 1 year post-CABG (P=.022).
  • Individual therapy doses remained largely unchanged across all time points.

Conclusions:

  • HFrEF GDMT utilization and individual therapy doses are suboptimal after CABG.
  • Enhanced collaboration among cardiac surgeons, heart failure cardiologists, and pharmacists is recommended to optimize GDMT use and dose titration.

Keywords:
coronary artery bypass graftingguideline directed medical therapyheart failure with reduced ejection fraction

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