Key result
Pharmacist-led recommendations show moderate-to-almost-perfect agreement with physician GDMT titration decisions across four drug classes.
Why the study?
Do pharmacist-led Medication Therapy Adherence Clinic recommendations align with physician prescribing decisions for guideline-directed medical therapy uptitration in heart failure management?
Cohort (n=108)
Do pharmacist-led Medication Therapy Adherence Clinic recommendations align with physician prescribing decisions for guideline-directed medical therapy uptitration in heart failure management?
Pharmacist-led Medication Therapy Adherence Clinic recommendations show moderate to almost perfect agreement with physician prescribing decisions across all four classes of heart failure guideline-directed medical therapy, supporting their role in multidisciplinary titration optimization.
Answers are grounded in this paper and cite their sources.
Pharmacist-physician agreement on GDMT uptitration supports collaborative titration protocols; reinforces multidisciplinary implementation in heart failure guidelines.
Background Optimising guideline-directed medical therapy (GDMT) is fundamental in heart failure management, and pharmacist-led Medication Therapy Adherence Clinics (MTAC) frequently support physicians by recommending medications titration. However, the degree of concordance between pharmacist recommendations and physician prescribing remains insufficiently characterised. Objective To evaluate the reliability of pharmacist-led MTAC recommendations by measuring their alignment with physician-prescribed GDMT titrations across four drug classes: renin-angiotensin-aldosterone system inhibitors (RAAS), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA) and sodium-glucose co-transporter 2 inhibitors (SGLT2i). Materials & methods A retrospective analysis of 108 titration encounters was conducted. Pharmacist recommendations and physician actions were classified into four predefined groups: (1) partial dose increase, (2) full dose increase, (3) no change, and (4) dose reduction / discontinuation. Crosstabulation, chi-square tests and Cohen's Kappa statistics were used to assess association and agreement beyond chance. Results Agreement between pharmacist recommendations and physician prescribing decisions was substantial for RAAS inhibitors (κ = 0.679) and MRA (κ = 0.627), and moderate for beta-blockers (κ = 0.593). The highest level of agreement was observed for SGLT2 inhibitors, demonstrating almost perfect concordance (κ = 0.910). All agreement measures were statistically significant (*p* < 0.001), indicating consistent alignment between pharmacist-led MTAC recommendations and physician decision-making across all GDMT classes. Conclusion The high level of agreement observed across GDMT classes underscores the value of pharmacist-led MTAC services as a reliable adjunct to physician decision-making, particularly in optimising heart failure therapy through multidisciplinary collaboration.
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Chan et al. (2026) conducted a cohort in Heart failure (n=108). Pharmacist-led Medication Therapy Adherence Clinic (MTAC) GDMT titration recommendations vs. Physician-prescribed GDMT titration decisions was evaluated on Agreement between pharmacist recommendations and physician prescribing decisions across four GDMT classes (RAAS inhibitors, beta-blockers, MRA, SGLT2 inhibitors) (κ = 0.593 to 0.910, p=<0.001). Pharmacist-led MTAC recommendations showed statistically significant agreement with physician GDMT titration decisions across all four drug classes (κ=0.593 to 0.910; p<0.001).
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