Inpatient pharmacist impact on guideline directed medical therapy in heart failure with reduced ejection fraction

Pharmacists play a vital role in optimizing care for patients with heart failure with reduced ejection fraction (HFrEF), as this subtype has well-established, evidence-based pharmacotherapy with proven positive clinical outcomes.

This retrospective observational cohort study aimed to assess the impact of inpatient pharmacist workflow designed to manage optimization of maximally tolerated guideline-directed medical therapy (GDMT) in patients with nonadvanced HFrEF.

The primary outcome was implementation of maximally tolerated GDMT via inpatient clinical and transition-of-care (TOC) pharmacist interventions specifically measured by new therapies added, price checks completed, barriers of therapy documented, medication counseling performed by TOC pharmacists and pillar assessment on discharge. The secondary outcome was 30-day all-cause readmission rates stratified by pharmacist involvement. All pharmacist efforts were measured using documentation provided via intervention reports generated from January 1, 2024, to December 31, 2024.

Both inpatient clinical pharmacists and TOC pharmacists participated with making interventions. 575 patient encounters were included in the pharmacist analysis, with 146 patients receiving therapy optimization through 218 pharmacist interventions, the majority of which were therapy initiation. TOC pharmacist discharge review and/or counseling was performed for 486 patient encounters during same time frame, 52% (299/575) of which were included in the analysis as they overlapped with inpatient clinical pharmacist review. Regarding secondary outcomes, 180 patients with heart failure were readmitted in 2024 with 31 meeting the criteria for non-advanced HFrEF. Amongst these 31, 12 (38.7%) had received clinical and TOC pharmacist review during their previous admission, while the remaining 19 (61.3%), serving as the control group, had not received comprehensive pharmacist review.

Inpatient and TOC pharmacist clinical review is associated with improved optimization of GDMT and may enhance value-based outcomes such as hospital readmissions.