P109 - PHARMACIST-LED TITRATION CLINIC FOR HFREF MEDICATION : RESULTS FROM ITS FIRST 2 YEARS OF EXISTENCE

Saturday, October 29, 2022

5:00 PM – 5:15 PM EDT

Location: Room 201

Presenter(s)

Istok Menkovic, MD

PGY3
Université de Montréal
Université de Montréal
Montreal, Quebec, Canada

First Author(s)

Istok Menkovic, MD

PGY3
Université de Montréal
Université de Montréal
Montreal, Quebec, Canada

Author(s)

ES

Erick Schampaert

Head, Division of Cardiology, Professor of Medicine, University of Montreality
Hôpital Sacré-Coeur de Montreal, CIUSSS NIM / Université de Montréal
University ofMontreal
Montreal, Quebec, Canada
MC

Marie-Christine Champagne

Montréal, Quebec, Canada
AH

Alexios Hadjis

Montréal, Quebec, Canada
RH

Raja Hatem

Cardiologist
Hopital du Sacre-Coeur de Montreal
Montréal, Quebec, Canada
TN

Thuy Anh Nguyen

Montréal, Quebec, Canada
FP

Frédéric Poulin

Montréal, Quebec, Canada
SW

Simon Williams

Montréal, Quebec, Canada

Senior Author(s)

SC

Stéphanie Carreau

Montréal, Quebec, Canada

Author(s)

SC

Stéphanie Carreau

Montréal, Quebec, Canada

Senior Author(s)

RK

Rémi Kouz

Cardiologist
HSCM
Montreal, Quebec, Canada

Supervisor(s)

RK

Rémi Kouz

Cardiologist
HSCM
Montreal, Quebec, Canada

Background: Based on multiple randomized controlled trials, guidelines-directed medical therapies (GDMT) to target or maximally tolerated doses is recommended for patients with heart failure with reduced ejection fraction (HFrEF), reducing morbidity and mortality. However, recent large registries have shown failure of initiation and up-titration of GDMT in clinical settings, not providing optimal medical therapy (OMT). . Pharmacists could play a role in increasing the proportion of patients on OMT. Scarce literature suggests titration of HFrEF medications by pharmacists is safe and effective, using pre-approved protocols by medical staff. Recent provincial governmental regulation, providing pharmacists with the possibility of prescribing and adjusting medications, was the impetus to the creation of a pharmacist-led HFrEF titration clinic at the Sacre-Coeur Hospital in Montreal. This study aims to describe the results of the first 2 years of existence of this clinic.

METHODS AND RESULTS: This is a retrospective study, of prospectively collected data, including all patients who completed follow-up to the clinic between 2018 and 2020. Following referral by treating cardiologist for HFrEF medication titration, patients were assessed by a pharmacist who reviewed and amended HFrEF medication list, while also evaluating its clinical and paraclinical tolerance. At referral, 96/97 (99%) patients were receiving a BB, 93/97 (96%) were receiving either an ACEi, an ARB, or an ARNI, and 40/72 (61%) were receiving a MRA. One of 97 patients (1%) was considered on OMT upon referral. The mean duration of follow-up was 113+/-75 days for a mean of 6+/-3 visits. At completion, 79/97 (81%) of patients were on OMT, according to contemporary guidelines. 92/97 (95%) were receiving BB, 95/97 (98%) of patients were receiving either ACEi, ARB, or ARNI when indicated, , and 54/72 (75%) were receiving MRA (when indicated) at target or maximally tolerated doses. Two adverse events of acute kidney injury were recorded, but there was no statistically significant difference in estimated glomerular filtration rate (eGFR) at referral vs at completion of follow-up (73+/-19 mL/min/1,73m2 vs 72+/-17 mL/min/1,73m2, p=0,2806).

Conclusion: This is the first reported experience of a Canadian, completely autonomous, pharmacist-led titration clinic in the literature. Results from its first 2 years of existence suggest it is a safe and effective way to optimize the proportion of HFrEF patients on OMT.