Expanded Results from a Dedicated Guideline-Directed Medical Therapy Clinic

Abstract

Background: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: GDMT; heart failure; implementation.