Evaluate the role of the clinical pharmacist in improving quality indicators on initiation of guideline-directed medical therapy in patients with heart failure with reduced ejection fraction in the cardiac unit

Abstract

Background: European Society of Cardiology 2021 developed quality indicators(QIs) for the care and outcomes of adult patients with heart failure with reduced ejection fraction (HFrEF) that contain a domain for initial management with guideline-directed medical therapy (GDMT) that includes β-blocker (B.B), angiotensin receptor–neprilysin inhibitor(ARNI) or angiotensin converting enzyme inhibitor (ACEI), mineralocorticoid receptor antagonist (MRA), and sodium glucose cotransporter 2 inhibitor (SGLT2I) that reduces mortality and hospitalizations.

Objective: To identify the role of the clinical pharmacist in the improvement of QI regarding initiation of GDMT in patients with HFrEF.

Methods: A descriptive observational study was conducted at the cardiac care unit of Baghdad Teaching Hospital - Medical City from February 2023 to January 2024, including adult patients with HFrEF. Among the multidisciplinary heart team at CCU, clinical pharmacists suggest optimising the initiation of GDMT based on updated recommendations from American or European guidelines for the management of HFrEF.

Result: From a total 324 patients included in the study, 264(81%) patients were eligible for one or more GDMT classes, and among 145(55%) clinical pharmacists interventions suggested for initiation of GDMT, that approved by physicians the most QI improvement found for MRA 54 (37%) intervention while ACEI/ARNI, B.B and SGLT2I was 39 (27%), 27 (19%) and 25 (17%) interventions respectively.

Conclusion: The role of the clinical pharmacist is essential among the cardiac team in improving QIs in the initiation of GDMT prescription for patients with HFrEF. The clinical pharmacist mainly improved QIs for initiation of MRA.