RESUMO
Efforts to optimize guideline-directed medical therapy (GDMT) through team-based care may affect outcomes in patients with heart failure with reduced ejection fraction (HFrEF). This study evaluated the impact of an innovative medication optimization clinic (MOC) on GDMT and outcomes in patients with HFrEF. Patients with HFrEF who are not receiving optimal GDMT are referred to MOC and managed by a team comprised of a nurse practitioner or physician assistant, clinical pharmacist, and HF cardiologist. We retrospectively evaluated the impact of MOC (n = 206) compared with usual care (n = 412) with a 2:1 propensity-matched control group. The primary clinical outcome was the incidence of HF hospitalizations at 3 months after the index visit. Kaplan-Meier cumulative event curves and Cox proportional hazards regression models with adjustment were conducted. A significantly higher proportion of patients in MOC received quadruple therapy (49% vs 4%, p <0.0001), angiotensin receptor neprilysin inhibitor (60% vs 27%, p <0.0001), mineralocorticoid receptor antagonist (59% vs 37%, p <0.0001), and sodium-glucose cotransporter-2 inhibitor (60% vs 10%, p <0.0001). The primary outcome was significantly lower in the MOC versus the control group (log-rank, p = 0.0008). Cox regression showed that patients in the control group were more than threefold more likely to be hospitalized because of HF than those in the MOC group (p = 0.0014). In conclusion, the MOC was associated with improved GDMT and lower risk of HF hospitalizations in patients with HFrEF.
