Pharmacist-Led Guideline-Directed Medical Therapy (GDMT) Clinic for the Optimization of Medications for Heart Failure with Reduced Ejection Fraction

Document Type

Conference Proceeding

Publication Date

2025

Publication Title

Journal of Cardiac Failure

Abstract

Introduction

Guidelines for heart failure with reduced ejection fraction (HFrEF) recommend 4 pillars of pharmacotherapy to reduce morbidity and mortality. Observational data consistently report an underutilization of GDMT-4 and dosing below target. The goal of the pharmacist-led GDMT clinic is to improve utilization of medications and optimization to the target dose or the patient's maximum tolerated dose in an expedited and safe manner.

Objective

To assess the impact of a pharmacist-led GDMT clinic on achievement of optimal GDMT-4 doses and improvement in EF.

Methods

Patients ≥ 18 yo with HFrEF (EF < 40%) referred by a HF provider to a pharmacist embedded within the HF clinic for GDMT optimization from 10/2022 - 12/2023 were analyzed. Patients receiving dialysis, pregnant or congenital heart conditions were excluded. The pharmacist works under a collaborative practice agreement which allows for prescribing of medication and ordering of labs. The goal is to have patients on target doses of the 4 pillars by the end of 12 weeks. Over the 12 weeks, patient appointments are in-person or telephone calls. In-person appointments are shared with a registered nurse, who completes a physical exam, obtains a medication history, and draws labs as needed. The pharmacist then reviews current GDMT therapy, vital signs, signs and symptoms of HF and adjusts medications as appropriate. Patient concerns with medication adherence or financial barriers are addressed along with social barriers if applicable. Target doses were defined as sacubitril/valsartan 97/103mg twice daily, losartan 50mg or greater daily, lisinopril 40mg daily, metoprolol succinate 200mg daily, carvedilol 25mg twice daily, spironolactone 25mg daily or eplerenone 50mg daily and dapagliflozin or empagliflozin 10mg daily.

Results

Over the study period, 132 patients graduated from the GDMT clinic. Ninety-nine (74%) were male and 32 (24%) had a diagnosis of ischemic cardiomyopathy and baseline EF of 23 ± 8.54%. Patients averaged 9±3.7 weekly appointments which resulted in 27 (20%) patients being on target doses for all 4 pillars and 94 (71%) patients on all 4 pillars at any dose. Upon follow up, there were improvements in EF with 44% (n=58) of patients achieving EF of ≥ 10% above baseline to ≥ 40%. Three patients were hospitalized for HF during or up to 90 days after GDMT titration, and 3 patients died within 90 days completing GDMT appointments.

Conclusions

A pharmacist-led GMDT titration clinic within a HF clinic led to increased number of patients achieving target doses of medications within 12 weeks with significant improvement in EF. Further studies will explore comparisons with standard office visits and implications for best practices for HF management.

Volume

31

Issue

1

First Page

228

Comments

Heart Failure Society of America (HFSA) Annual Scientific Meeting, September 27-30, 2024, Atlanta, GA

Last Page

228

DOI

10.1016/j.cardfail.2024.10.124

ISSN

1532-8414

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