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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Medication optimization clinic decreases hospitalizations and mortality for patients with heart failure with reduced
James C Coons1,2, Jennifer Kliner2, Michael A Mathier2
1Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, United States of America.
Insights
A medication optimization clinic (MOC) significantly improved guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF). This led to reduced hospitalizations and mortality in HFrEF patients.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Guideline-directed medical therapy (GDMT) is crucial for managing heart failure with reduced ejection fraction (HFrEF).
- Optimizing GDMT can be challenging in routine clinical practice.
- Medication Optimization Clinics (MOCs) offer a structured approach to improve medication management.
Purpose of the Study:
- To evaluate the impact of a Medication Optimization Clinic (MOC) on GDMT adherence and clinical outcomes for patients with HFrEF.
- To compare outcomes of patients managed by MOC with those receiving usual care.
Main Methods:
- Retrospective evaluation of a multi-site MOC program within a large health system.
- Comparison of 1419 patients in the MOC group with 5116 control patients receiving usual care.
- Analysis of GDMT use, heart failure (HF) hospitalizations, cardiovascular (CV) hospitalizations, and all-cause mortality using competing risk analysis.
Main Results:
- MOC patients demonstrated significantly higher rates of quadruple therapy, ARNI, beta-blocker, MRA, and SGLT2 inhibitor use compared to controls.
- Competing risk analyses revealed significantly lower HF and CV hospitalizations at 3, 6, and 12 months for the MOC group.
- All-cause mortality was significantly lower at 6 and 12 months in the MOC group, but not at 3 months.
Conclusions:
- MOCs are effective in improving GDMT adherence for HFrEF patients.
- MOC intervention is associated with reduced HF and cardiovascular hospitalizations.
- MOCs contribute to decreased all-cause mortality in patients with HFrEF.
Study Objective:
To evaluate the impact of a medication optimization clinic (MOC) on GDMT and outcomes for patients with HFrEF versus usual care.
Design:
Retrospective evaluation of a multi-site MOC was conducted.
Setting:
Large health system with academic and community hospitals.
Participants:
Patients with HFrEF referred to MOC by their cardiologist versus usual care.
Interventions:
GDMT use managed by an advanced practice provider or clinical pharmacist through weekly telemedicine visits.
Main Outcome Measures:
The primary outcome was HF hospitalization. Cardiovascular hospitalization and all-cause mortality were also assessed. Kaplan-Meier Curve, Cumulative Incidence Function, and competing risk analysis with regression models were conducted.
Results:
1419 patients in MOC group were compared to 5116 control patients. GDMT use was significantly higher in MOC: quadruple therapy (49 % vs. 19 %; p < 0.0001), angiotensin-receptor neprilysin inhibitor (62 % vs. 45 %; p < 0.0001), beta blocker (92 % vs. 88 %; p < 0.0001), mineralocorticoid receptor antagonist (69 % vs. 45 %; p < 0.0001), and sodium glucose cotransporter-2 inhibitor (68 % vs. 35 %; p < 0.0001). Competing risk analyses showed that HF and CV hospitalizations were significantly lower at all times points (3, 6, and 12 months) for MOC vs. control (p < 0.001). All-cause mortality was significantly lower at 6 months (p = 0.006) and 12 months (p < 0.001), but did not differ at 3 months (p = 0.35), for MOC vs. control.
Conclusions:
MOC was associated with improved GDMT and lower risks of hospitalizations due to HF and any cardiovascular cause, and all-cause mortality in patients with HFrEF.
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