(VP048) EVALUATION OF PHARM-HF, A PHARMACIST-LED HEART FAILURE MEDICATION TITRATION CLINIC.

Background: The PHARM-HF clinic is a pharmacist-led medication optimization clinic for heart failure with reduced ejection fraction (HFrEF) which accepts referral from hospital-based cardiologists. PHARM-HF provides co-management by a dedicated clinical pharmacist via remote encounters, aiming to achieve maximum-tolerated HFrEF guideline-directed medical therapy (GDMT) as outlined by the latest Canadian Cardiovascular Society heart failure guidelines. This study assessed changes in GDMT use, along with intermediate outcomes, in patients attending PHARM-HF.

METHODS AND RESULTS: This retrospective pre-post study evaluated consecutive patients attending PHARM-HF from January 2021 to February 2023. The primary outcome was the modified Optimal Medication Therapy (OMT) score, an aggregate score of HFrEF quadruple therapy. OMT score was categorized as suboptimal (score 0-4), acceptable (score 5-7) or optimal (score 8; all four drugs at max-tolerated dose). Secondary outcomes included the change in proportion receiving quadruple therapy and target-dose quadruple therapy, change in left ventricular ejection fraction (LVEF) from baseline to 1 year, and Kansas City Cardiomyopathy Questionnaire-12 (KCCQ; range 0 [worst] to 100 [best]). from baseline to clinic discharge.

We included 81 patients. Median age was 68, 21% were female, 44% were in New York Heart Association class 2, and median LVEF was 31%. The median OMT improved from 6 (IQR 4-7) at baseline (7% categorized as optimal), to 8 (IQR 8-8) at clinic discharge (p < 0.001; 78% categorized as optimal). At baseline, 30% received quadruple therapy, including 2% at target doses of all four medications, which increased to 78% and 16%, respectively, at clinic discharge. KCCQ-12 overall summary score improved from a median of 62 to 77, and LVEF improved from a median of 30% to 38% at 1 year follow-up.

Conclusion: A pharmacist-led HFrEF medication optimization clinic significantly increased achievement of GDMT, which was associated with improvements in patient-reported quality of life and LVEF. A pilot randomized controlled trial is currently underway (ClinicalTrials.gov Identifier: NCT05623358) to guide the development of a multicentre trial to provide definitive evidence for the role of pharmacist-led medication optimization in HFrEF.