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. 2022 Dec;15(6):1424-1435.
doi: 10.1007/s12265-022-10262-9. Epub 2022 May 2.

Impact of Pharmacist-Led Heart Failure Clinic on Optimization of Guideline-Directed Medical Therapy (PHARM-HF)

Tanvi Patil  1 , Salihah Ali  2 , Alamdeep Kaur  2 , Meghan Akridge  2 , Davida Eppes  2 , James Paarlberg  2 , Amitabh Parashar  2 , Nabil Jarmukli  2
Affiliations

Impact of Pharmacist-Led Heart Failure Clinic on Optimization of Guideline-Directed Medical Therapy (PHARM-HF)

Tanvi Patil et al. J Cardiovasc Transl Res. 2022 Dec.

Abstract

This prospective study included patients with heart failure (HF) with reduced ejection fraction (HFrEF) with LVEF < = 40% to evaluate the impact of pharmacist on guideline directed medical therapy (GDMT). The primary outcome was to compare proportion of triple GDMT achieved for Angiotensin-Converting-Enzyme-Inhibitors (ACEI)/Angiotensin-Receptor-Blockers (ARB)/Angiotensin-Receptor-Neprilysin-Inhibitors (ARNI), beta-blockers, aldosterone antagonists (AA), and quadruple GDMT which in additional to triple therapy, included Sodium glucose co-transporter 2 inhibitor (SGLT2i) at 90-day post-enrollment compared to baseline. Secondary endpoints included achieving target and/or maximally tolerated ACEI/ARB/ARNI and beta-blockers combined and individually as well as SGLT2i and AA GDMT at 90-day post-enrollment compared to baseline. We also compared combined and individual HF-related hospitalization/emergency room (ER) visits 90 days pre-/post-enrollment. Of the total 974 patients screened, 80 patients seen at least once in the heart failure medication titration clinic (HMTC) were included in the analysis. Median (IQR) age was 71 (57-69) years with majority white male. There was a significant improvement in the proportion of patients who achieved quadruple GDMT (p = 0.001) and triple GDMT (p-value = 0.020) at 90-day post-enrollment compared to baseline. The secondary GDMT outcomes were also significantly increased at 90 days post-enrollment compared to baseline. Significant difference in mean as well as proportion of combined HF-related hospitalization/ER-visits was found 90 days pre-/post-enrollment (p = 0.047). Our study found that pharmacist's intervention increased the proportion of patients who achieved GDMT at 90 days.

Keywords: ACE inhibitor; Aldosterone antagonist; B-adrenergic blockers; Congestive heart failure; Guideline-directed medical therapy (GDMT); KCCQ-12; Medication therapy management; Pharmacists; Sodium glucose co-transporter 2 inhibitor; Veterans.

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Conflict of interest statement

Tanvi Patil, Salihah Ali, Alamdeep Kaur, Meghan Akridge, Davida Eppes, James Paarlberg, and Amitabh Parashar have nothing to disclose.

Nabil Jarmukli has the following conflict of interest to disclose pertaining to one of the drugs utilized in this study:

  1. 2017–2021: Principal Investigator BI Salem VA Medical Center, EMPEROR-Reduced Study

  2. 2017–2021: Principal Investigator BI Salem VA Medical Center, EMPEROR-Preserved Study

KCCQ-12 Instrument for Clinical Users was purchased for use during the study duration.

Figures

Fig. 1
Fig. 1
Patient selection
Fig. 2
Fig. 2
Enrollment flowchart and possible interventions evaluated
See this image and copyright information in PMC

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