Authors (including presenting author) :
Lo LY(1), Siu LT(1)
Affiliation :
(1) Department of Pharmacy, Pok Oi Hospital
Introduction :
Heart Failure (HF) is a public health concern with increasing overall incidence. Guidelines on HF management has emphasized the importance of early initiation and achievement of target dose of guideline-directed medical therapy (GDMT). However, the role of pharmacist has not been evaluated in the local setting. This study aims to elucidate the impact of Pharmacist Heart Failure Clinic (PHFC) on achieving the target dose/maximally tolerated dose of GDMT and HF-related readmission.
Objectives :
The primary outcome of the study was to assess the utilization of GDMT, including ACEI/ARB/ARNI, beta blockers, and MRAs, by measuring the proportion of patients achieving the target dose and maximally tolerated dose for each class of GDMT, and the proportion of target dose achieved for each class of GDMT. The period of measurement was 12 months from enrollment, until patients discharged from PHFC/medical appointment, or until patients passed away, whichever occurred first.
The secondary outcomes of the study were HF-related unplanned readmission rate and HF-related mortality rate at the 3rd, 6th, and 12th month after enrollment.
Methodology :
PHFC has been operational since October 2020. We retrospectively studied a total of 329 patients with diagnosis of HF with left ventricular ejection fraction of ≤ 40% between 1st October 2020 and 30th November 2022. 147 patients received pharmaceutical care from the PHFC (PHFC group), and 182 patients received usual standard of care (control group). Detailed review of medical records was conducted to compare the proportion of patients achieving target dose or maximally tolerated dose of GDMT [angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), angiotensin receptor/neprilysin inhibitor (ARNI), beta blockers and mineralocorticoid receptor antagonists (MRAs)] and HF-related readmission rate between both groups. Propensity score matching was conducted to compare the outcomes.
Result & Outcome :
Significantly higher proportion of patients in the PHFC group achieving maximally tolerated dose of all three classes of GDMT (ACEI/ARB/ARNI: 81.4% vs 27.8%, p< 0.001; beta blockers: 79.4% vs 34.0%, p< 0.001; MRAs: 78.4% vs 36.1%, p< 0.001) when compared with patients in the control group. Patients in the PHFC group was associated with significantly lower 12-month HF-related readmission (HR 0.423 (95% CI 0.230 – 0.779), p=0.006) compared with patients in the control group.
Participation in PHFC increased the proportion of patients achieving target dose/maximally tolerated dose of three classes of GDMT, including ACEI/ARB/ARNI, beta blockers and MRAs, and was associated with a lower 12-month HF-related readmission.
