Guideline-directed medical therapy use in unfunded patients with heart failure with reduced ejection fraction within an academic health system

Objectives Heart failure (HF) remains a major cause of hospitalizations and mortality globally, despite advances in therapeutics. Quadruple therapy is the foundation for guideline-directed medical therapy (GDMT) of HF with reduced ejection fraction (HFrEF). Despite proven benefits, proper GDMT in everyday practice is underutilized. The purpose of this study is to evaluate outpatient prescribing patterns of GDMT in unfunded HFrEF patients and its impact on clinical outcomes within a large county health system. Materials and Methods A retrospective chart review was conducted for unfunded adult outpatients with a visit diagnosis of HFrEF based on an echocardiogram. Information collected for each study subject included rates of prescribed GDMT, target doses achieved, adherence, pharmacist involvement in dose titration, and hospitalizations/mortality. Results Of the 3219 patients with a chart diagnosis of HFrEF, 232 patients met the inclusion criteria. Triple therapy was prescribed in 60.3% of patients, while 36.2% were prescribed quadruple therapy. Among the study population, 87.1% were on guideline-directed beta-blocker (BB), 48.3% on angiotensin-converting enzyme inhibitors (ACEI), or angiotensin receptor blockers (ARB), 31% on angiotensin receptor/neprilysin inhibitor (ARNI), 72.4% on a mineralocorticoid receptor antagonist (MRA), and 52.2% were on a sodium-glucose cotransporter 2 inhibitor (SGLT2i). Prescribing rates of target doses of ACEI/ARB, ARNI, BB, MRAs, and SGLT2i were 29.5%, 13.9%, 23.2%, 81.5%, and 90.1% respectively. GDMT titration was performed by pharmacists on 12.9% of patients. Conclusion Significant underutilization of GDMT and optimal dose titration remain within a large health system. Clinical pharmacists within our institution were intermittently involved in optimizing GDMT within the patient population. This study suggests there are opportunities for pharmacists to assist with GDMT optimization.