In 17 nurse-led heart failure clinics, over 80% of patients achieved guideline-directed medical therapy across the four pillars with a mean time to achievement of 10.3 weeks.
Observational (n=344)
Yes
Does nurse-led management achieve timely guideline-directed medical therapy in heart failure patients?
Nurse-led heart failure clinics in Ireland successfully achieved guideline-directed medical therapy across four pillars in over 80% of patients within a mean of 10.3 weeks.
Abstract Background Heart failure (HF) is a life limiting and debilitating condition and the cornerstone of HF management is pharmacotherapy with studies showing clinically significant improvements (including improved survival rates).1,2 In patients with reduced ejection fraction (left ventricular ejection fraction (LVEF) ≤40%), the four pillars to Guideline Directed Medical Therapy (GDMT) are an ACE-inhibitor, angiotensin receptor blocker or an angiotensin receptor-neprilysin inhibitor, beta blockers, Mineralocorticoid receptor antagonist and Sodium Glucose Co-transporter 2 inhibitor medications. The recommendation is that HF patients should be prescribed these medications and have them titrated to the maximal doses over a 12-week period. GDMT has demonstrated improved survival where timely initiation of therapies are initiated, however significant gaps in practice have been reported.2 Purpose The aim of the audit was to review current practice in nurse-led HF clinic and to determine if timely GDMT across the 4 pillars was occurring. Methods An audit of GDMT in HF clinics was undertaken in 2025 across HF services in Ireland in collaboration of the Irish Nurses Heart Failure Association and data analysis was undertaken using SPSS. Results A total of 344 HF cases were audited across 17 HF clinics with 246 (72%) male, mean age 66 years (± 13), the majority (n=235, 68%) had Ejection Fraction (EF) 35%, 40 (12%) EF between 36% and 39% and 69 (20%) EF between 40-49% and 22% (n=74) were diagnosed with Diabetes. In terms of blood tests, the HF nurse undertook the majority of baseline blood tests (n=237, 69%) with 20% (n=68) of bloods taken in hospital and 11% (n=37) in primary care. In relation to timely GDMT, over 80% (n=270) achieved GDMT across the four pillars with the remaining 20% ongoing HF GDMT management. Reasons for targets not being achieved include hypotension, bradycardia and renal dysfunction. The mean time to achieve GDMT was 10.3 weeks (± 5.5). The majority of patients were seen in face-to-face appointments for their first visit (n=337, 98%). The mean number of follow-up appointments was 2.7 (± 1.5) and these were primarily face-to-face. Conclusion Overall, the audit revealed a high proportion of GDMT application within the recommended 12 weeks in nurse-led HF clinics was achieved and where medications were not initiated or target not achieved, the rationale for target not been met was documented.
Cronin et al. (Wed,) conducted a observational in Heart failure (n=344). Nurse-led heart failure clinic management was evaluated on Achievement of GDMT across the four pillars. In 17 nurse-led heart failure clinics, over 80% of patients achieved guideline-directed medical therapy across the four pillars with a mean time to achievement of 10.3 weeks.