Evaluation of PHARM-HF, a pharmacist-led heart failure medication titration clinic

Introduction: The PHARM-HF clinic is a novel, pharmacist-led medication optimization clinic for patients with heart failure with reduced ejection fraction (HFrEF). PHARM-HF aims to achieve maximum-tolerated HFrEF guideline-directed medical therapy (GDMT) as outlined by the latest Canadian Cardiovascular Society heart failure guidelines.Methods: This retrospective pre-post study evaluated consecutive patients attending PHARM-HF (January 2021-August 2022). The primary outcome was the modified Optimal Medication Therapy (mOMT) score, an aggregate score of HFrEF quadruple therapy. The mOMT score was categorized as suboptimal (score 0-4), acceptable (score 5-7), or optimal (score 8; all four drugs at maximum tolerated dose). Secondary outcomes included change in left ventricular ejection fraction (LVEF) from baseline to 1 year, and Kansas City Cardiomyopathy Questionnaire-12 (KCCQ; range 0 [worst] to 100 [best]) from baseline to discharge.Results: Of 81 included patients, median age was 68 years, 21% were female, 61% had New York Heart Association (NYHA) class 2 functional capacity, and median LVEF was 30%. Median mOMT improved from 6 (interquartile range [IQR] 4-7) at baseline to 8 (IQR 7-8) at clinic discharge (p < 0.001; increase from 7% to 73% categorized as optimal). LVEF improved from a median of 30% to 38% at 1 year (p < 0.001). Among 16 patients who completed the KCCQ-12 at both time points, the score was 62 at baseline and 77 at discharge (p = 0.42).Conclusions: Uptake of GDMT significantly increased from admission to discharge from the PHARM-HF medication optimization clinic, during which other cardiovascular clinicians did not modify HFrEF medications. Furthermore, there was an improvement in LVEF at 1 year. A pilot randomized controlled trial is currently underway to guide the development of a multicenter trial to provide definitive evidence for the role of pharmacist-led medication optimization in HFrEF.