Abstract 15410: Obstacles to Implementation in a Heart Failure Nurse Practitioner and Pharmacist Lead Guideline Directed Medical Therapy Program

Background: The aim of this study was to describe differences in baseline characteristics of patients who did or did not complete a HF-GDMT optimization program at our institution and who reached vs did not reach target doses of therapies.

Methods: We instituted a structured program in September 2020 led by a heart failure nurse practitioner and clinical pharmacist to optimize GDMT in a safe and expedited manner that involved telephone visits and labs every 2 weeks. Since this is an exploratory analysis differences between groups were reported with p values <0.10.

Results: A total of 247 patients were enrolled. The average age of the cohort was 62.3 (13.9), 31% were women, 53% had new onset within 6 months of enrollment, and 66% were nonischemic. Overall, 198 (80%) patients completed the program and 49 (20%) did not. Non-completers were more likely to have transportation limitations (25% vs 5%; p<0.001 ), to be on Medicare or Medicaid (76% vs 54%; p=0.009 ), to be referred to a prescription assistance program (33% vs 21%; p=0.084 ), and were less likely to have commercial insurance (18% vs 39%; p=0.008 ). Among patients who completed the program only 48 (24.3%) reached the recommended doses of all medicines and 150 (75.7%) did not. Patients who reached the recommended doses were younger (mean age 57.5 vs 64.4; p= 0.002), and were more likely to have nonischemic vs ischemic cardiomyopathy (29% vs 16%; p=0.078) and chronic vs new onset disease (31% vs 18%; p=0.046). Patients under 50 were far more likely to reach target doses compared to those >80 (46% vs 4%).

Conclusions: Important differences in patients who did or did not complete the program and who reached or did not reach target doses were identified. These differences help identify implementation challenges in real-world settings.