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Non-Physician-Led Models of Care for Heart Failure Medication Optimization: A Scoping Review
Blair J MacDonald1, Nathaniel M Hawkins2, Fritha Munday3
1Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
CJC Open
|July 22, 2026
Summary
Non-physician-led heart failure (HF) care models improve medication use compared to baseline. However, their effectiveness versus usual care varies due to implementation differences.
Area of Science:
- Cardiology
- Pharmacology
- Healthcare Management
Background:
- Non-physician-led care models show promise for enhancing heart failure (HF) medication management.
- Understanding these models is crucial for effective implementation in clinical practice.
Purpose of the Study:
- To characterize non-physician-led models of heart failure (HF) medication management.
- To evaluate their impact on medication utilization.
Main Methods:
- A systematic literature search was conducted across major databases (MEDLINE, Embase, CENTRAL, CINAHL) from January 2005 to October 2024.
- Studies focused on outpatient non-physician-led HF medication management were included and assessed for quality using the Oxford Centre for Evidence-Based Medicine levels.
- Data from 31 studies involving 16,921 participants were analyzed.
Main Results:
- Pharmacists and nurse practitioners/clinicians were the most common non-physician roles studied.
- Medication management occurred in-person, remotely, or via hybrid approaches, with varying appointment frequencies and durations.
- While non-physician-led models increased HF medication use compared to baseline, results were mixed when compared to usual care regarding guideline-directed medical therapy.
Conclusions:
- Non-physician-led models demonstrate potential for improving heart failure medication adherence.
- Significant heterogeneity exists in implementation strategies, influencing the comparative effectiveness against usual care.
- Further research is needed to optimize these models for consistent guideline-directed medical therapy improvements.
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