Background: Management of heart failure with reduced ejection fraction (HFrEF) requires timely initiation and up-titration of guideline-directed medical therapy (GDMT). In safety-net hospitals (SNHs), limited health care staff and resources make achievement of optimal medical therapy challenging. Recent studies have shown that medication titration performed by clinical pharmacists can improve outcomes in ambulatory management of HFrEF; however, the impact of these services within an SNH remains unknown. Objective: Determine the impact of integrating clinical pharmacists into a heart failure (HF) clinic on initiation and titration of GDMT within an SNH. Methods: We performed a single-center retrospective cohort study of patients with HFrEF treated in an ambulatory HF medication titration clinic within an SNH before and after clinical pharmacist integration. Primary outcomes included dose optimization rates of GDMT, time between clinic visits, and time to optimization of GDMT. Exploratory secondary outcomes were all-cause, HF, and cardiovascular acute care service utilization and all-cause, HF, and cardiovascular mortality before and after clinical pharmacist integration up to 6 months after initial clinic visit. Results: A total of 153 patients with HFrEF were treated. Baseline characteristics in the preand postintervention groups were comparable. After clinical pharmacist integration, there was a statistically significant improvement in optimization of renin-angiotensin-aldosterone system inhibitor or hydralazine-nitrate equivalent (82% vs. 94%, P ¼ 0.02). Dose optimization rates of beta-blockers (90% vs. 83%, P ¼ 0.22) and mineralocorticoid receptor antagonists (57% vs. 57%, P > 0.99) were unchanged. There was a statistically significant reduction in mean time between clinic visits (26 vs. 14 days, P < 0.001) and in mean time to optimization of GDMT (88 vs. 45 days, P ¼ 0.002). All-cause mortality was reduced (13% vs. 2%, P ¼ 0.01). Conclusion:In SNHs, where limited health care staff and resources present as barriers to timely initiation and titration of GDMT, integration of clinical pharmacists into HF clinics can serve as a practical solution.

The aim of this analysis was to determine the characteristics of COVID19 patients assessed by critical care dietitians during the COVID19 pandemic. Methods: Nutrition parameters were collected for all patients admitted to the intensive care unit (ICU) with COVID19 and a length of stay (LOS) >48hrs. Data was compared from March-June 2020 (T1) to January-April 2021 (T2). Results: 64 patients in T1 and 77 patients in T2 were assessed by a critical care dietitian and 100% required nutrition support. Mean age in T1 was 60.6yrs (66% male) compared to 63.1yrs in T2 (62% male). Mean BMI was 29.6kg/m 2 in T1 and 30.2kg/m 2 in T2.72% of patients required mechanical ventilation in T1 and 78% in T2 with the remainder on non-invasive ventilation (NIV). During T1 78% transferred to ward level care with 48% in T2. The average ICU LOS of 16 days in T1 and 22 days* in T2 (*2 patients remain in ICU at time of data analysis). Of those that transferred to the ward 100% required on going dietetic input at both time periods. In T1 41% were discharged on enteral nutrition (EN) and 50% discharged on EN in T2. Type of nutrition support during ICU stay is described in the table below.