A Pharmacist Medication Titration Program for Patients with Cardiac Sarcoidosis and Systolic Heart Failure: A Retrospective Cohort Study.

Abstract

Background: A multidisciplinary approach improves guideline-directed medical therapy (GDMT) in systolic heart failure (HF), but its efficacy in patients with HF due to cardiac sarcoidosis (CS) is unreported.

Methods and results: In a retrospective cohort study, we reviewed 848 patients from our institutional CS clinics, identifying those with a CS diagnosis, HF (LVEF < 50%) at index evaluation, and echocardiograms within 90 days and 11-36 months. Patients were stratified by participation in a pharmacist-led medication therapy management (MTM) program for GDMT optimization (MTM vs non-MTM [NMTM]) without randomization. Demographics, LVEF, GDMT (quantified by Kansas City Medical Optimization [KCMO] score), and immunosuppressive therapy were assessed. Primary outcomes included changes in KCMO score, LVEF, and cardiovascular event-free survival (unplanned HF hospitalization, LVAD/heart transplant, or death). The final cohort included 111 patients (median age 57 years, 34% female, 64% NYHA Class I-II); 43 (39%) were MTM and 68 (61%) were NMTM. Mean KCMO score was similar at index evaluation (MTM: 23.2; NMTM: 29.6, p=0.83). At follow-up (median 16 months), the KCMO score increased significantly in both groups (MTM: 23.2 to 74.8, p<0.001; NMTM: 29.6 to 58.7, p<0.001), but was higher in MTM (p=0.001). Mean LVEF trended towards higher values in MTM (44.4% vs 40.0%, p=0.05). The primary clinical outcome occurred in 1 MTM (2.3%) and 16 NMTM (23.5%) patients, with higher risk in NMTM (HR 11.97 [95%CI 1.58 - 90.54], p=0.002).

Conclusions: In this retrospective cohort study, a pharmacist-led MTM program was associated with favorable GDMT optimization and lower risk of adverse cardiovascular outcomes in CS patients with HF.