Expanded Results from a Dedicated Guideline-Directed Medical Therapy Clinic

Implementation of guideline directed medical therapy (GDMT) for heart failure (HF) care in general cardiology environments is suboptimal. A dedicated GDMT clinic was expanded to include individuals with HF across the full spectrum of left ventricular ejection fraction (LVEF).

Referred individuals were seen by advanced practice providers until maximally tolerated therapy was achieved. Achievement of optimal GDMT was evaluated and compared to patients from usual care matched in a 1:2 fashion. Key prognostic HF indicators were assessed.

The mean (SD) age of 92 GDMT-eligible clinic participants was 66.5 (15.4) years, 25 (27.2%) were female;18 (19.6%) had LVEF ≥50%. From baseline to follow-up visit (12.9 weeks), the number of patients eligible for optimal GDMT with LVEF <50% increased from 12.0% to 91.3% (p<0.001); among eligible individuals with LVEF ≥50%, optimal GDMT increased from 5.6% to 77.8% (p=0.001). There was an increase in the proportion on optimal GDMT at ≥50% target dose (1.1% to 50.0%) and at target dose (0.0% to 30.4%). These changes were substantially greater than in the matched cohort of usual care patients. Among GDMT patients, significant improvements were observed in symptoms, NT-proBNP and important echocardiographic measurements. Kansas City Cardiomyopathy Questionnaire Overall and Clinical Summary Scores both significantly increased by 8 points (p=0.01) and 6-minute walk distance increased by 37 meters (p=0.03). GDMT administration was safe and well tolerated.

Successful implementation of GDMT in a dedicated clinic embedded within a general cardiology practice was well-tolerated and effective to improve key outcomes across the entire spectrum of LVEF.