Establishing the first pharmacist-led heart failure medication optimization clinic in the Middle East Gulf Region

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.