Guideline-directed medical therapy in heart failure patients: impact of focused care provided by a heart failure clinic in comparison to general cardiology out-patient department

Abstract

Background The usage of guideline-directed medical therapy (GDMT) in the treatment of heart failure (HF) has shown to reduce morbidity and mortality. However, majority of the HF patients do not receive GDMT or do not achieve the target dose. Literature has shown that the patients who are managed in HF clinics receive GDMT and target doses of disease-modifying drugs (DMD) when compared to those treated in other general cardiology outpatient departments (OPD’s). It was a retrospective hospital-based study in which patients treated in HF clinic and other cardiology OPD in the year of 2017 were included (200 patients in each arm). The aim of this study was to assess the impact of heart failure clinics in medication therapy management including usage of guideline-directed medical therapy, if target dose specified by the guideline is achieved and time to reach target dose in comparison to other general cardiology OPD’s. IRB and IEC approval were obtained before the commencement of the study. Data relevant to the study were obtained from the electronic medical record (EMR) and were compared between the study groups to see for the adherence to guideline and achievement of target doses. Data storage and analysis were performed using SPSS Version 24. A significance level of 5% was used. Results The usage of GDMT was higher in HF clinic when compared to other cardiology OPD (81% vs 55%, P = 0.001). A significantly higher number of patients in HF clinic achieved target dose when compared to other cardiology OPD (58% vs 29% -betablockers, 45% vs 9% -ACEI/ARB/ARNI, P = 0.000). Moreover, the number of eligible patients receiving DMD was found to be higher in HF clinic (98% vs 85% -betablockers, 69% vs 44% -ACEI/ARB/ARNI, 76% vs 44% -MRA). Also, the patients in HF clinic attained the target doses faster when compared to other cardiology OPD. In addition, there was better improvement in ejection fraction, as well as decreased rate of rehospitalisation and mortality in patients managed in HF clinic. Conclusion HF clinics were compared with other cardiology OPD for various parameters and it was observed that HF clinics were better than other cardiology OPD in maintaining the medication therapy management.

Heart Function Clinics for Patients With Heart Failure

“…The clinical outcomes considered in the primary clinical studies included hospitalization, [9][10][11]13 mortality, 9,12,13 guideline-directed medical therapy, 9,10,12 improvement in ejection fraction, 9 primary care and emergency department visits, 10 and medication adherence. 14 The follow-up periods among the included studies ranged from 3 months to 2 years.…”

“…The 6 included primary clinical studies comprised 1 prospective cohort study 12 and 5 retrospective cohort studies. [9][10][11]13,14 The studies were published between 2017 and 2020.…”

“…The primary clinical studies were conducted by authors from India, 9 Israel, 10,12 and the US. 11,13,14 The economic evaluation studies were conducted by author(s) from Denmark 15 and Canada.…”

“…Three retrospective cohort studies [9][10][11] and 1 prospective cohort study 12 compared multidisciplinary HF clinics with usual care. One retrospective cohort study 13 compared data from a multidisciplinary HF clinic with the Centers for Medicare & Medicaid Services (CMS) data for the national average and surrounding area hospitals, while the other retrospective cohort study 14 compared data of patients attending a multidisciplinary HF clinic with historical controls who did not attend the HF clinic.…”

“…Despite differences in baseline patient characteristics between groups in all included studies, only 2 studies 10,14 adjusted for potential confounders in the analysis, while the other 4 studies did not. 9,[11][12][13] None of studies provided sample size calculations and therefore it was unclear if the studies had sufficient power to detect a statistically significant effect where the P value for a difference being due to chance is less than 5%. Overall, the methodological quality of the included studies was low.…”