2022 Quality Summit ePosters (Non-CE) - STS/ACC TVT Registry-3. Emphasizing Goal Directed Medical Therapy (GDMT) to Improve Clinical Outcomes

3. Emphasizing Goal Directed Medical Therapy (GDMT) to Improve Clinical Outcomes

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The study focused on guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) and examined the variability in prescribing patterns among different specialty practices. GDMT includes medications such as renin-angiotensin inhibitors (ACEi/ARB/ARNI), beta-blockers, mineralocorticoid receptor antagonists (MRA), and SGLT-2 inhibitors.<br /><br />Although GDMT has been proven to improve clinical outcomes and reduce morbidity and mortality in heart failure patients, its adoption remains low. The study aimed to increase the implementation of GDMT during hospital admission by analyzing the differences in prescribing patterns based on the admitting service and implementing quality improvement strategies.<br /><br />The results showed that the initiation of beta-blockers at discharge remained consistently high throughout the study period (>92%) for all service lines. However, the overall discharge rate for ACEi/ARBs was 75%, with slight variations between internal medicine (76.9%) and cardiology services (80%). The overall usage of ARNI was 40.7%, with higher rates in cardiology (66.7%) compared to internal medicine (31.6%). The initial prescription of ARNI was relatively low (8.3% for internal medicine and 14.3% for cardiology).<br /><br />To increase the utilization rates of GDMT, multiple strategies were implemented, including clinician education, interdisciplinary rounds, and heart failure process improvement meetings. The study used specific inclusion and exclusion criteria to analyze the data, focusing on patients with a principal diagnosis of heart failure and left ventricular ejection fraction (LVEF) <40%. Patients with certain contraindications or specific conditions were excluded from the analysis.<br /><br />The research findings highlight the need for improvements in the adherence to GDMT guidelines among specialty practices. The study recommends ongoing efforts to educate clinicians and implement quality improvement initiatives to enhance the implementation of GDMT and improve clinical outcomes in heart failure patients.<br /><br />References:<br />1. Heidenreich PA, Bozkurt B, Aguilar, D. et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.<br />2. Bhagat AA, Greene SJ, Vaduganathan M. et al. Initiation, Continuation, Switching, and Withdrawal of Heart Failure Medical Therapies During Hospitalization. Journal of American College of Cardiology: Heart Failure. 2019;7(1):1-12.

Keywords

GDMT

heart failure with reduced ejection fraction

prescribing patterns

ACEi

beta-blockers

MRA

SGLT-2 inhibitors

implementation

quality improvement strategies

clinical outcomes