Four-Year Impact of Including a Pharmacist in a Multidisciplinary Team on Guideline-Directed Medical Therapy for Heart Failure with Reduced Ejection Fraction: Experience at a Tertiary-Care Hospital in Thailand
Abstract
Objective: We evaluated the real-world data from Thailand regarding dosage optimization of guideline-directed medical therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF). We also assessed GDMT usage, drug-related problems (DRPs) over 4 years, and performance measures based on HF parameters and cardiac biomarkers. All were evaluated before and after a 1-year follow-up in the HF clinic, where pharmacists served on a multidisciplinary team.
Material and Methods: We conducted a retrospective chart review of patients with HFrEF who attended our HF clinic. Data on GDMT dosage optimization, usage, and DRPs were gathered from all patient visits between January 2020 and September 2023. Performance measures were collected from patients who completed a 1-year follow-up within the same period.
Results: Among 2907 patient visits over 4 years, the annual GDMT dose rates were 67.4% for beta-blockers, 92.6% for renin–angiotensin–aldosterone system (RAAS) blockade, 40.5% for sacubitril/valsartan, and 100.0% for mineralocorticoid receptor antagonists (MRAs) and sodium–glucose cotransporter-2 inhibitors (SGLT2i). The proportion of visits achieving more than 50% of the GDMT dose was 67.6%, 80.3%, 45.9%, 100.0%, and 100.0%, respectively. Overall, GDMT usage was 90.3% for beta-blockers, 72.0% for RAAS blockade, 78.7% for MRAs, and 35.3% for SGLT2i. Adverse drug reactions were the most frequent DRPs.
Conclusion: The inclusion of a pharmacist on a multidisciplinary team in a heart failure clinic can improve GDMT optimization, increase GDMT usage, and resolve DRPs, thereby enhancing therapeutic outcomes and quality of life.
Keywords
Full Text:
PDFReferences
Bozkurtet B, Ahmad T, Alexander K, Baker W, Bosak K, Breathett K, et al. Heart failure epidemiology and outcomes statistics: a report of the heart failure society of America. J Card Fail 2023;29:1412-51.
Savarese G, Kishi T, Vardeny O, Eryd S, Bodegård J, Lund L, et al. Epidemiology and burden of heart failure in asia. JACC J 2023;1:1–14.
McDonagh T, Metra M, Adamo M, Gardner R, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599–726.
Heidenreich P, Bozkurtet B, Aguilar D, Allen L, Byun J, Colvin M, et al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure: A report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. Circulation 2022;145:e895-1032.
Shahid I, Khan S, Fonarow C, Butler J, Greene S. Bridging gaps and optimizing implementation of guideline-directed medical therapy for heart failure. Prog Cardiovasc Dis 2024;82:61-9.
Savarese G, Kishi T, Vardeny O, Eryd S, Bodegård J, Lund L, et al. Heart failure drug treatment—inertia, titration, and discontinuation: A multinational observational study (utilization of Dapagliflozin and other guideline directed medical therapies in heart failure patients. J Am Coll Cardiol HF 2023;11:1–14.
Greene S, Butler J, Albert N, DeVore A, Sharma P, Duffy C, et al. Medical therapy for heart failure with reduced ejection fraction: The change the management of patients with heart failure registry. J Am Coll Cardiol 2018;72:351-66.
Docherty K, Anand I, Chiang C, Chopra V, Desai A, Kitakaze M, et al. Effects of dapagliflozin in Asian patients with heart failure and reduced ejection fraction in dapagliflozin in patients with heart failure and reduced ejection fraction. JACC Asia 2022;2:139–53.
Cao V, Cowley E, Koshman S, MacGillivray J, Sidsworth M, Turgeon R. Pharmacist-led optimization of heart failure medications: a systematic review. J Am Coll Clin Pharm 2021; 4:862-70.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.