Medication use in HFrEF following implementation of multidisciplinary heart failure model of care in a regional health service.

Abstract

Background: Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) recommends four classes of medications: angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI); beta blockers (BB); mineralocorticoid receptor antagonists (MRA); and sodium-glucose cotransporter-2 inhibitors (SGLT2i). In line with the Heart Failure Collaborative with Safer Care Victoria, a multidisciplinary model of care was implemented to enhance GDMT prescription. Methods: Patients admitted to Ballarat Base Hospital with HFrEF (ejection fraction <40%) from February to December 2022 were recruited and reviewed by a specialised heart failure nurse practitioner, pharmacist, and cardiologist documenting advice on GDMT. Results: A total of 112 patients were hospitalised with HFrEF. The mean age was 72 years, 34 (30%) were females and 78 (70%) males. Common comorbidities included 61 with hypertension (55%), 59 with ischaemic heart disease (53%), 51 with atrial fibrillation (46%), and 42 with diabetes (38%). Median length of stay was 7 days (interquartile range 4–13). On hospital discharge, the number of patients prescribed at least one drug, two drugs, three drugs, and all four drugs were 101 (90%), 85 (75.9%), 52 (46.4%), and 12 (11%), respectively. Eighty-nine (80%) patients were prescribed BB, 86 (77%) ACEi/ARB/ARNI, 62 (55%) MRA, and 15 (13%) SGLT2i. This is comparable with a systematic review of medication prescription across 11 studies, with prescription rates of 80.9% for ACEi/ARB, 78% for BB, and 47% for MRAs. Conclusion: Multidisciplinary interventions support medication uptake in hospitalised patients for successful implementation of clinical practice guidelines. Further research will include investigation of titration of these therapies post-discharge.