Heart Failure Diagnostic Alerts to Prompt Pharmacist Evaluation and Medication Optimization

The development of heart failure (HF) decompensation may precede clear and actionable symptoms. Cardiac implantable devices use sensor data to create an index score predictive of HF admission risk.

Patients at the West Palm Beach Veterans Affairs Healthcare System using the HeartLogic implantable device were monitored for 7 months by a cardiology clinical pharmacist practitioner (CPP). Interventions and metrics were tracked up to 42 days after an alert. The primary outcome was the number of CPP interventions to optimize guideline-directed medical therapy (GDMT).

There were 39 patients with a HeartLogic-capable device. Twenty-one alert encounters were analyzed in 16 unique patients who were contacted a mean of 5 days after the alert. Patients were on a mean 2.6 GDMT agents at baseline vs 3.0 agents at 42 days. There were 30 total medication interventions, with 27 successfully tolerated. The most common medication initiated was a sodium-glucose cotransporter type 2 inhibitor (SGLT2i) (41%), with 1 adverse effect leading to discontinuation. Optimization of SGLT2i therapy led to positive impacts on overall HeartLogic, S1, S3, impedance, respiratory rate, and activity scores. The median HeartLogic score decreased from 18 at baseline to 5 at 42 days (P < .001). Of patients with reported symptoms at the time of the alert, 77% experienced subjective improvement.

CPP-led HF interventions triggered by HeartLogic alerts led to effective patient identification, reductions in HeartLogic scores, symptom improvement, and optimization of HF care.