(P155) EVALUATING THE IMPACT OF PHARMACY-LED GUIDELINE DIRECTED MEDICAL THERAPY IN A HEART FUNCTION CLINIC

Background: Guideline Directed Medical Therapy (GDMT) for appropriately selected patients with heart failure and reduced ejection fraction (HFrEF) is considered the optimal treatment based on strong evidence from clinical trials demonstrating reduced mortality and morbidity data. The 2021 Canadian Cardiovascular Society Guidelines support initiation and up titration of HF pharmacotherapy as soon as possible, ideally, within 3-6 months (McDonald, 2021). Despite supporting evidence, these therapeutics remain underutilized and patients at the greatest risk of hospitalization and mortality are often among those least likely to receive optimal doses of treatment (Jeffries, 2018). Despite the importance of pharmacotherapy in HFrEF, the adoption of pharmacist-led titration has been slow in the Canadian healthcare environment. Our implementation study was designed to evaluate the impact of pharmacist-led medication titration of GDMT in appropriate patients compared to historic controls from 2019. McDonald, M. et al. 2021. CCS/CHFS Heart Failure Guidelines Update: Defining a New Pharmacologic Standard of Care for Heart Failure With Reduced Ejection Fraction. Can. J. Cardiol. 37(4):531–546.
Jefferies, JL and Ibrahim, NE. 2018. Are Guidelines Merely Suggestions? J. Am. Coll. Cardiol. 72(4):367–369.

METHODS AND RESULTS: This quality improvement cohort study was conducted at a single tertiary care centre at Royal Jubilee Hospital, HF Clinic with patients eligible for GDMT and with an LVEF < 40%. The study involved a retrospective chart review of a cross-section of patients referred to the HF clinic between Nov 2018-May 2019 to act as a control group prior to the pharmacy position being created (41 patients), and a longitudinal, prospective study of patients seen by the HF clinic, including the pharmacist between Nov 2020 and Oct 2021 (35 patients). Importantly, the addition of a pharmacist to the HF clinic led to higher proportions of patients on GDMT (Table 1) and a remarkable reduction in time to maximum tolerated medication titration of GDMT (mean 76 days pharmacy vs. 80% of the control group requiring > 6 months). Notably, there were numerically fewer hospitalizations/urgent care visits at 12 months (5.6/1000 in the pharmacy cohort vs 13.1/1000 in the control group).

Conclusion: Pharmacists have a specialized understanding of pharmacotherapy, drug interactions, medication management, and dose titrations and are trained in patient engagement and education around medication adherence and lifestyle changes. This implementation study reinforces the importance of including pharmacists in multidisciplinary HF clinics to improve patient outcomes, decreased heart failure hospitalizations, and shorten the time to maximum tolerated utilization of GDMT.