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Updated: Jul 1, 2025
09:20
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
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Evaluation of Guideline-Directed Medical Therapy for Outpatients Living with Heart Failure with Reduced Ejection
Taylor McVannel1, Lori Albers2, Lynette Kosar3
1, BScPharm, ACPR, CDE, is the Manager of Pharmacy, Brandon Regional Health Centre, Brandon, Manitoba.
The Canadian Journal of Hospital Pharmacy
|March 14, 2024
Summary
Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) was suboptimal in nearly half of patients. Intolerance was a key reason for not optimizing GDMT, highlighting a treatment gap.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Pharmacotherapy, specifically guideline-directed medical therapy (GDMT) comprising four foundational medications, is central to managing heart failure with reduced ejection fraction (HFrEF).
- Current adherence to GDMT recommendations in clinical practice for HFrEF remains largely uncharacterized.
Purpose of the Study:
- To assess the proportion of HFrEF patients receiving optimized GDMT.
- To detail achieved dosages of foundational HFrEF medications.
- To identify documented reasons for suboptimal GDMT optimization.
Main Methods:
- A retrospective cohort study was conducted.
- Medical records of 129 HFrEF patients treated at the Regina Heart Function Clinic (HFC) as of December 31, 2021, were analyzed.
Main Results:
- Only 47.3% of patients were prescribed optimized GDMT.
- Optimized use varied by drug class: renin-angiotensin system inhibitors (82.2%), mineralocorticoid receptor antagonists (80.6%), beta-blockers (79.1%), and SGLT2 inhibitors (74.4%).
- Lack of documented rationale for suboptimal GDMT was common (35.8%); medication intolerance was the primary stated reason (33.0% for utilization, 57.6% for dosing).
- Pharmacists documented 553 patient care activities for 58.9% of patients outside scheduled appointments.
- 12.4% of patients experienced 31 heart failure-related hospitalizations in 2021.
Conclusions:
- A significant treatment gap exists in GDMT for HFrEF patients despite multidisciplinary care.
- Findings will guide improvements in clinic processes for identifying and optimizing GDMT in HFrEF patients.
- Enhanced pharmacist involvement may improve GDMT optimization and reduce hospitalizations.
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