Pharmacist-Led Heart Failure Stewardship to Optimise Guideline Directed Medical Therapy.

Abstract

Aim: For patients with heart failure (HF), hospitalisation presents an opportunity to review and optimise HF guideline directed medical therapy (GDMT). We investigated the effect of a pharmacist-led HF stewardship program to intensify HF GDMT (addition of GDMT class and/or increase dosage of GDMT) for general medical patients. Method(s): Utilising a custom-built electronic medical record dashboard to identify patients, we implemented a stewardship program for patients with HF admitted under general medicine at a tertiary hospital. The stewardship team consisted of a clinical pharmacist and a heart failure cardiologist. The pharmacist identified eligible patients, drafted GDMT optimisation recommendations, discussed recommendations with the cardiologist and agreed on a plan. Recommendations were documented and communicated to the medical team. The service was conducted remotely, using electronic medical records. Results were compared to a 2023 baseline audit. Result(s): HF stewardship review was provided for 262 admissions from May-October 2024. Median age was 81 years (IQR 71-86), 50% of admissions were for patients with HF with reduced ejection fraction, 50% with HF with preserved ejection fraction. One or more of the stewardship recommendations were actioned in 205 admissions (78.2%). Of those eligible for GDMT intensification, 108/202 (53.5%) received intensification of their HF GDMT by discharge, compared to 35/172 (20.3%) in the baseline audit (p=<0.00001). Conclusion(s): This novel HF stewardship model provides a blueprint for hospitals to provide GDMT optimisation to general medical patients, in an efficient and effective manner. Future research should focus on expanding the model, and investigating impact on reducing HF readmissions.Copyright © 2025