Authors (including presenting author) :
Chan KL (1), Siu CC (1), Lee A (1), Ho WH (1) Lee E (1), Fan K (2), Wong SL (2), Cheng KY (2), Wong KF (2), Wong KL (2)
Affiliation :
(1)Pharmacy Department, (2)Cardiac Medical Unit, Grantham Hospital
Keyword 1: :
Pharmacist Heart Failure Clinic
Keyword 2: :
Heart Failure
Keyword 3: :
Guideline directed medical therapy
Introduction :
In patients with heart failure with reduced ejection fraction (HFrEF), accelerated dose titration of Guideline-Directed Medical Therapy (GDMT) to target doses has been shown to improve survival, quality of life, and reduce hospitalisations. However, since physician appointment schedules are often at full capacity, the frequent follow-ups necessary to achieve optimal doses could be challenging in real-world settings. In October 2023, a Pharmacist-led Heart Failure Clinic (PHFC), in close collaboration with heart failure physicians and nurse specialists, was established at Grantham Hospital, a tertiary referral centre for advanced heart failure to focus on dose titration and pharmacotherapy monitoring.
Objectives :
To evaluate the effectiveness of PHFC in optimising GDMT and improving clinical outcomes in patients with advanced heart failure.
Methodology :
In a retrospective, single-group, pre-post study, we evaluated patients enrolled in PHFC from October 2023 to November 2025, with the following outcomes:
1) Number and proportion of patients achieving ≥ 50% of GDMT target doses after enrolment
2) Time to achieve target doses among patients who attained GDMT target doses after enrolment
3) Heart failure-related hospitalisations within 1 year before and after enrolment
4) Changes in left ventricular ejection fraction (LVEF) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) level from enrolment to up to 1 year after enrolment
Result & Outcome :
A total of 207 patients were enrolled. At baseline, Sacubitril/Valsartan, Beta-blockers, Mineralocorticoid Receptor Antagonists (MRA), and Sodium-glucose co-transporter 2 inhibitors (SGLT2i) were prescribed to 203 (98%), 192 (93%), 175 (85%), and 179 (86%) patients, respectively. The number of patients achieving ≥50% of GDMT target dose increased from 96 (47%) to 159 (78%) for Sacubitril/Valsartan, 56 (29%) to 91 (47%) for Beta-blockers, and 119 (68%) to 161 (92%) for MRA. The median time to achieve target doses among patients who attained GDMT target doses after enrolment was 3 months (IQR 2-6.5 months) for Sacubitril/Valsartan, 4 months (IQR 2-6 months) for Beta-blockers and 2 months (IQR 1-3 months) for MRA. There were 114 patients with ≥ 1 year follow-up. Heart failure-related hospitalisations decreased significantly from 0.66 to 0.29 (78.8%, p < 0.001). LVEF and NT-proBNP levels from enrolment to up to 1 year after enrolment were available for 37 and 40 patients respectively. LVEF increased significantly by 45.3% (p< 0.001), whereas NT-proBNP levels decreased significantly by 32% (p< 0.05). Our PHFC offers a viable approach for GDMT dose titration, effectively balancing evidence-based up-titration with patient tolerability. This retrospective study demonstrates that accelerated dose titration can be achieved effectively in this patient group. Incorporating pharmacists into the multidisciplinary heart failure team enhances patient outcomes through proactive medication management and therapeutic monitoring.
