The Impact of a Nurse Led Guideline Directed Medical Therapy Clinic

Background Heart failure with reduced ejection fraction (HFrEF) is a leading cause of rehospitalizations, high morbidity and mortality. Current guidelines recommend the use of Guideline Directed Medical Therapy (GDMT) at maximum tolerated doses which have shown to improve outcomes. Unfortunately, Methods We conducted a retrospective chart review of existing patient data in a single center teaching hospital of patients referred to a nurse led GDMT clinic primarily staffed with heart failure trained nurses, physician assistants and cardiologists. Protocols for the initiation and uptitration of GDMT were developed based on existing guidelines. Our primary objective was to determine whether enrollment into a nurse led GDMT clinic would increase the proportion of patients with HFrEF on appropriate medications at doses. Our secondary objective was to determine the benefit on renal function, hospital admissions, mortality and implantable defibrillator shocks. Results Between November 2015 to November 2017, 61 patients were enrolled into the clinic. Mean duration of follow up was 264.44 days. Mean ejection fraction (EF) was 21.8%. New onset HFrEF (diagnosed 90 days) comprised 48% of the population. Patients with NYHA class III comprised 65% of the population. There was a statistically significant increase in the mean number of GDMT at any dose (2.31 to 2.74; p: Fig 1 ). There was a significant increase in utilization of ARNI and AA while a significant decrease in utilization of ACE-I ( Fig 2 ). There was a significant improvement in EF from 21.8% to 36.2% (p: Conclusions This pilot study showed that a nurse led GDMT titration program successfully increased the number of GDMT at target doses that patients were able to tolerate, all the while enhancing functional status, EF, sodium and chloride levels, with a reduction in rehospitalization rates.