Abstract 16261: Pharmacy-Led Optimization of Guideline-Directed Medical Therapy in Heart Failure With Reduced Ejection Fraction Program Improves Heart Failure Metrics in a Safety-Net Hospital
Gabrielle Barbera, Kelsey Norman, Meissane Lee, Kyle Jones, Alexandra Pipilas, Kelly Wulff, Alana Surjanhata, Ludwine Paul, Monica Ahluwalia, Matthew G Nayor, Deepa M Gopal- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Introduction: Quad-therapy with guideline-directed medical therapy (GDMT) improves HFrEF outcomes but is challenging to implement in safety-net centers. We expanded an outpatient pharmacy-led medication titration program (OPTIMAL-HF) to improve HF care.
Research Question: Does a safety-net pharmacy-led program lead to significant change in medication rates, all-cause/HF admissions, and HF metrics?
Methods: From a Boston Medical Center HF hospital discharge or ambulatory visit, 122 patients were referred. A cardiology clinical pharmacist conducted either in-person/telemedicine visits. Scales and blood pressure monitors were provided for remote monitoring. HF GDMT was titrated based on an algorithm until goal doses/maximally tolerated doses of GDMT were achieved signaling OPTIMAL-HF graduation. Chart review was performed with an approved IRB.
Results: Of the 28 graduates of the program, 76% were Black/Hispanic, 71% resided in an area deprivation index ≥ 5 (scale, 1-10, higher score signifying greater neighborhood disadvantage). The median time to complete the program was 22 weeks (interquartile range (IQR) 8, 29 weeks) with median of 6 visits (IQR 3, 8 visits). In the 3 months prior to program enrollment, there were 13 hospitalizations (8 due to HF); in the 3 months after OPTIMAL-HF graduation (n=20), only 3 hospitalizations (0 due to HF) were noted. At graduation, 64% were on quad-therapy with 100% on beta-blockers, 96% on ace-inhibitors/angiotensin-receptor blocker/angiotensin-receptor-neprilysin inhibitor, 71% on mineralocorticoid receptor antagonist, and 89% on sodium-glucose cotransporter-2 inhibitors. An increased number of OPTIMAL-HF graduates reached maximum-tolerated/goal doses of GDMT with significant improvements in LVEF ( Figure)
Conclusions: OPTIMAL-HF improved HF metrics including medication rates, all-cause/HF hospitalizations, and LVEF in graduates of this program supporting an effective model in a safety-net center.