(1022) Evaluation of Heart Failure with Reduced Ejection Fraction (HFrEF) Guideline Directed Medical Therapy Regimens​

Objectives: Heart failure is a prevalent disease which is a leading cause of hospitalizations. Early initiation of guideline directed medical therapy (GDMT) is recommended to reduce morbidity and mortality; however, many patients are on suboptimal GDMT therapy. The purpose of this study is to evaluate prescribed treatment for heart failure patients at Blount Memorial Physician Group (BMPG) clinics in Maryville, TN and determine the number of patients on GDMT and correlation to hospitalizations.

Methods: This is an IRB- approved, retrospective study evaluating prescribed treatment for heart failure with reduced ejection fraction (HFrEF) patients. A report generated from a large third-party payor was used to identify patients with HFrEF (LVEF ≤ 40%) managed by BMPG primary care providers or cardiologists between July 1, 2022 to June 30, 2023. Patients were eligible for inclusion into the study if they had an ICD-10 code that corresponds to the diagnosis of HFrEF and are 18 years old or older. A randomized sample of 100 patients was analyzed.

Data analyzed included the following: medication, dosing, and the number of avoidable hospitalizations and emergency department visits. Descriptive statistics were used to analyze the percentage of patients taking each class of GDMT medications and the rate of hospitalization or emergency room visits to determine if linked to suboptimal GDMT regimens.

Results: Overall, GDMT including appropriate beta- blockers (bisoprolol, carvedilol, metoprolol succinate), sodium-glucose cotransporter 2 (SGLT-2) inhibitors (dapagliflozin or empagliflozin), mineralocorticoid receptor antagonists (spironolactone or eplerenone), and renin- angiotensin- aldosterone system (RAAS) inhibitors (angiotensin- converting enzyme (ACE-I), angiotensin receptor blocker (ARB), angiotensin receptor/neprilysin inhibitor (ARNI)) optimization was poor among patients analyzed. Of the 100 patients analyzed, 13% of patients were on 0 GDMT agents, 37% of patients were on 1 GDMT agent, 41% of patients were on 2 GDMT agents, 9% of patients were on 3 GDMT agents, and 0% of patients were on 4 GDMT. Each class of medications percent utilization was analyzed. The class least utilized were SGLT-2 inhibitors while the class most utilized were RAAS inhibitors. In addition, beta- blocker utilization and goal doses were analyzed. Only 25% of patients were on one of the three beta- blockers indicated for HFrEF. Of these patients, only 2% of patients were taking target doses of their beta- blocker. There were 61 total emergency room visits and 8 total avoidable hospitalizations reported. 63 of these occurred with patients who were taking less than or equal to 2 GDMT recommended therapies. Overall, GDMT was found to be underutilized and correlated to emergency room visits and avoidable hospitalizations.

Conclusions: Implementation of targeted review of HFrEF patient medications regimens for GDMT could warrant improvement in optimizing GDMT utilization. Suboptimal GDMT regimens indicate a crucial role a pharmacist could play in interventions to optimize GDMT for HFrEF patients. These interventions could contribute not only to optimizing GDMT regimens but also to reducing emergency room visits and avoidable hospitalizations.