(CCSP059) A PRESCRIBING PHARMACIST AND NURSE LED MEDICATION OPTIMIZATION CLINIC VERSUS USUAL CARE ON OPTIMIZATION OF GUIDELINE DIRECTED MEDICAL THERAPY IN HEART FAILURE WITH REDUCED EJECTION FRACTION

Background: Guidelines recommend that medication optimization for patients with heart failure with reduced ejection fraction (HFrEF) should occur within 3 - 6 months of diagnosis. Real-world data suggests this is rarely attained. We sought to determine whether a novel approach to guideline directed medical therapy (GDMT) titration/optimization with a prescribing pharmacist and a registered nurse in a structured format enables greater optimization compared to usual outpatient heart failure clinic care.

METHODS AND RESULTS: An electronic retrospective chart review was conducted and included all patients in the pharmacist + nurse clinic and consecutive adult patients in the usual care arm (1:3). The pharmacist + nurse clinic was embedded in the Heart Function Clinic and patients were referred by clinic providers (January 2022-March 2023). These patients were compared to patients newly accepted to the Heart Function Clinic (November 2021 – September 2022). All patients were required to have an LVEF < 40%. The primary objective was to compare the proportion of patients optimized on GDMT within 6 months. Secondary objective included changes in utilization of GDMT classes and doses.

A total of 52 and 148 patients were included in the pharmacist + nurse clinic and usual care arms respectively. The groups were mostly similar at baseline, with an average age of 63 years and 23% female. At 6 months, the pharmacist + nurse team optimized 80.8% of patients compared to 37.2% of patients in usual care (mean difference 43.6%, 95% confidence interval 1.1% - 86.1%, p-value 0.0043). In those optimized, it took on a mean of 16.7 days longer and 6.74 more encounters in the pharmacist + nurse clinic. There was no significant difference in mean change of Heart Failure Collaboratory Score (2.42 vs 1.69 point, pharmacist + RN and usual care respectively). Utilization of all classes except beta-blockers was higher in the pharmacist + nurse clinic (Table 1).

Conclusion: A pharmacist + nurse model with structured up-titration of GDMT embedded within a heart failure clinic is more effective at optimizing medications in patients with HFrEF at 6 months compared to usual care in the same clinic. This novel model should be implemented as a strategy to optimize HFrEF GDMT.