(P121) UTILITY OF A MEDICAL OPTIMIZATION CLINIC IN HEART FAILURE PATIENTS WITH AN IMPLANTED CARDIAC DEVICE

Background: Guideline-directed medical therapy (GDMT) reduces mortality in patients with heart failure with reduced ejection fraction. However, GDMT is not uncommonly de-escalated following implanted cardioverter defibrillator (ICD) implantation. We describe our experience with the Device Medical Optimization Clinic (DMOC) at Hamilton Health Sciences, which was established to facilitate medical therapy optimization in cardiac device patients.

METHODS AND RESULTS: All patients who visited DMOC between September 9, 2020, and December 22, 2021, were analysed (n=121). Mean age was 70.5 (±9.8) years, and 77.7% of patients were male. A total of 32.2% had ischemic cardiomyopathy, 23.1% had heart failure hospitalization within the previous year, and 43.0% had a CRT-D. Mean left ventricle ejection fraction was 32.4% (± 11.4%). At baseline, 76.9%, 89.3%, and 24.8% were on an ACE inhibitor/ARB/ARNI, beta blocker, and mineralocorticoid receptor antagonist (MRA), respectively. After the first DMOC visit, the use of ACE inhibitor/ARB/ARNI increased to 85.1%, which was driven by an overall increase in the use of ARNI from 27.3% to 44.6% (p < 0.001). In addition, 14.9% of patients had their ACE inhibitor/ARB/ARNI dose increased. Use of beta blockers increased to 92.6% (p=0.13), and 14.9% increased their beta blocker dose (p < 0.001). Use of MRAs increased to 34.7% (p=0.0015). An SGLT-2 inhibitor was started in 14.0% of patients (p < 0.001).

Conclusion: Participation in DMOC led to an increase in the proportion of patients on GDMT and dose increases in prognostically-significant medical therapy. Cardiac device clinics present a unique opportunity to identify patients on suboptimal GDMT who would benefit from medical therapy optimization.