Background-Most heart failure (HF) risk stratification models were developed for inpatient use, and available outpatient models use a complex set of variables. We hypothesized that routinely collected clinical data could predict the 6-month risk of death and all-cause medical hospitalization in HF clinic outpatients.

BackgroundHeart failure (HF) patients derive a dose‐dependent clinical benefit from medications that are part of guideline‐directed medical therapy (GDMT). The widespread underdosing of these medications and the clinical implications of the lack of titration have been well documented. There is paucity of data on design and outcomes of pharmacist‐led HF clinics.AimThe aim of this study is to describe the establishment of the first pharmacist‐led HF pharmacotherapy clinic (HFPC) in the Middle East gulf region.MethodsThis is a retrospective study of patients seen by the HF pharmacotherapy clinic. We determined the percentage of patients on target doses of GDMT at baseline and at the end of follow‐up in the subgroup of patients with HF with reduced ejection fraction (HFrEF). All baseline self‐care behaviors and interventions performed were examined.ResultsThe first 100 patient referrals and 193 visits were included in this analysis for an average of 1.9 ± 1.4 visits per patient and a mean follow‐up period of 51 ± 36.1 days. Most patients (94%) had HFrEF and were referred to from the outpatient clinics (72%). Many patients (76%) had at least one inadequacy in medication adherence or self‐care behaviors at baseline, and none were on simultaneous target doses of all GDMTs. At the end of follow‐up, more patients with HFrEF were on target doses when compared with baseline (beta‐blockers 31.9% vs 40.4%, P = .032, angiotensin‐converting enzyme inhibitor/angiotensin II receptor blocker/angiotensin II receptor blocker neprilysin inhibitor 7.4% vs 25.5%, P < .001, mineralocorticoid receptor antagonist 37.2% vs 39.4% P = .46, all three target GDMTs 0% vs 6.4%, P = .093). Significantly, more patients were on any dose of all three GDMTs.ConclusionsPharmacist‐led HF medication optimization clinic establishment can contribute to longitudinal medication titration, successful transition of care, and correcting noncompliance and indiscretions. Pharmacists are in an ideal position to fill gaps and help evolve the current HF care model.

PurposeThe purpose of this paper is to explore and critically review the existing literature on applications of Lean Methodology (LM) and Discrete-Event Simulation (DES) to improve resource utilization and patient experience in outpatient clinics. In doing, it is aimed to identify how to implement LM in outpatient clinics and discuss the advantages of integrating both lean and simulation tools towards achieving the desired outpatient clinics outcomes.Design/methodology/approachA theoretical background of LM and DES to define a proper implementation approach is developed. The search strategy of available literature on LM and DES used to improve outpatient clinic operations is discussed. Bibliometric analysis to identify patterns in the literature including trends, associated frameworks, DES software used, and objective and solutions implemented are presented. Next, an analysis of the identified work offering critical insights to improve the implementation of LM and DES in outpatient clinics is presented.FindingsCritical analysis of the literature on LM and DES reveals three main obstacles hindering the successful implementation of LM and DES. To address the obstacles, a framework that integrates DES with LM has been recommended and proposed. The paper provides an example of such a framework and identifies the role of LM and DES towards improving the performance of their implementation in outpatient clinics.Originality/valueThis study provides a critical review and analysis of the existing implementation of LM and DES. The current roadblocks hindering LM and DES from achieving their expected potential has been identified. In addition, this study demonstrates how LM with DES combined to achieve the desired outpatient clinic objectives.

Background: A cardiac lipoma is a rare primary cardiac tumor. They are usually asymptomatic and carry a good prognosis. Cardiac Magnetic Resonance Imaging (CMR) is the confirmatory investigation of choice. Case presentation: We present a case of left ventricular lipoma in an asymptomatic patient, which was successfully treated with surgical resection. Conclusion: Cardiac lipomas are rare and are usually benign. There is no guideline on the management of cardiac lipomas and treatment is individualized.

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