JACC. Case reports · 2026
Improving Guideline-Directed Medical Therapy in Hospitalized HFrEF Patients: A Multidisciplinary Quality Improvement Initiative.
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Khan Abdul Allam, Amaral Matthew, Ghaie Manav, Rashid Huzaifa, Iannuccilli Jenna
Аннотация
BACKGROUND: Guideline-directed medical therapy (GDMT) reduces mortality and rehospitalization in heart failure with reduced ejection fraction (HFrEF), yet many hospitalized patients are discharged without optimal therapy.
PROJECT RATIONALE: A baseline audit at our community teaching hospital showed fewer than half of eligible patients were discharged on ≥3 GDMT pillars, driven by cost barriers, deferred titration, and inconsistent education.
PROJECT SUMMARY: A multidisciplinary Plan-Do-Study-Act intervention standardized GDMT workflows, incorporating pharmacist-led admission review, structured checklists, teach-back counseling, a meds-to-beds program, and early outpatient follow-up. Among 62 postintervention versus 152 baseline patients, discharge on ≥3 pillars increased from 47.4% to 69.4% (P = 0.006), heart failure-specific 30-day readmissions decreased from 23.7% to 9.7% (P = 0.022), and all-cause readmissions from 30.9% to 16.1% (P = 0.028).
LIMITATIONS: Modest postintervention sample size warrants cautious interpretation.
TAKE-HOME MESSAGE: Structured, pharmacy-supported GDMT workflows improved prescribing performance and reduced 30-day readmissions in HFrEF.
PROJECT RATIONALE: A baseline audit at our community teaching hospital showed fewer than half of eligible patients were discharged on ≥3 GDMT pillars, driven by cost barriers, deferred titration, and inconsistent education.
PROJECT SUMMARY: A multidisciplinary Plan-Do-Study-Act intervention standardized GDMT workflows, incorporating pharmacist-led admission review, structured checklists, teach-back counseling, a meds-to-beds program, and early outpatient follow-up. Among 62 postintervention versus 152 baseline patients, discharge on ≥3 pillars increased from 47.4% to 69.4% (P = 0.006), heart failure-specific 30-day readmissions decreased from 23.7% to 9.7% (P = 0.022), and all-cause readmissions from 30.9% to 16.1% (P = 0.028).
LIMITATIONS: Modest postintervention sample size warrants cautious interpretation.
TAKE-HOME MESSAGE: Structured, pharmacy-supported GDMT workflows improved prescribing performance and reduced 30-day readmissions in HFrEF.