Outcomes of a hybrid heart failure clinic model on optimization of guideline-directed medical therapy

Abstract

Background

Achieving rapid titration of guideline-directed medical therapy (GDMT) for patients with heart failure may be challenging due to limited clinical resources.

Objective

This study aimed to evaluate the effectiveness of a hybrid clinic model led by pharmacists in optimizing GDMT.

Methods

A single-center, retrospective analysis compared patients with an ejection fraction < 50% seen in a hybrid clinic model that included multidisciplinary in-person visits and pharmacist-led telehealth appointments (hybrid) to an in-person model that included only a cardiology provider (historical). The primary end point was the number of GDMT medications prescribed per patient. An exploratory end point included a modified optimal medical therapy score (mOMT). Outcomes were analyzed using a linear mixed-effects model adjusting for baseline characteristics.

Results

Patients in the hybrid cohort (n = 52) increased from 2.5 to 3.1 GDMT at 3 months compared to 2.5 to 2.8 in the historical cohort (n = 46). There was a significantly greater increase in the average number of GDMT at each time interval in the hybrid cohort compared to the historical cohort (difference in changes per interval = +0.13; 95% CI: 0.05, 0.21). More patients were on quadruple therapy at the last study visit (48.1% vs 26.1%, P = 0.025), and the increase in mOMT was significantly higher in the hybrid cohort (difference in changes = +0.036; 95% CI: 0.015, 0.056).

Conclusions

The hybrid model involving pharmacists was associated with greater initiation of GDMT compared to in-person care without a pharmacist. This study confirms the valuable role of pharmacists in optimizing therapy for patients with heart failure.