Outcomes of a Pharmacist-Managed Heart Failure Medication Titration Assistance Clinic

The Annals of Pharmacotherapy
Shubha BhatVicki Groo

Abstract

National guidelines recommend angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) and β-blockers (BBs) at target doses for morbidity and mortality benefits in heart failure with reduced ejection fraction (HFrEF); regardless, titration of these therapies in practice remains suboptimal. We implemented an outpatient pharmacist-managed HFrEF medication titration assistance clinic (MTAC) at one institution to improve titration for general cardiology (GC) patients. To evaluate MTAC impact by determining the proportion of patients on target or maximum tolerated ACE inhibitor/ARB and BB doses. A retrospective chart review of adult patients with documented ejection fraction ≤40% managed in the MTAC or GC from 2011 to 2013 was conducted. HFrEF medication regimens were collected at initial visit and months 1, 2, 3, 6, 9, and 12 to assess titration. Target doses were defined per guideline or dose at which ejection fraction recovered during the study. Maximum tolerated doses were defined as the highest dose patients tolerated without physiological limitations. Of 148 patients, the MTAC managed 51 and GC managed 97. At baseline, 90% of MTAC versus 82% of GC patients were prescribed ACE inhibitors/ARBs and B...Continue Reading

References

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Citations

Sep 12, 2019·Current Treatment Options in Cardiovascular Medicine·Lucianne M WestKathleen D Faulkenberg
Jun 11, 2019·BioMed Research International·Yirga Legesse NiriayoMulugeta Tarekegn Angamo
Sep 18, 2020·European Heart Journal. Cardiovascular Pharmacotherapy·Seif El HadidiAndrew J S Coats
Jan 8, 2021·International Journal of Clinical Pharmacy·Seif El HadidiMargaret Bermingham
Dec 8, 2020·Canadian Pharmacists Journal : CPJ = Revue Des Pharmaciens Du Canada : RPC·Arden R Barry, Ricky D Turgeon
Aug 18, 2020·JACC. Heart Failure·Marilyne JarjourAnique Ducharme

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Software Mentioned

REDCap
MTAC

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