Protocol-driven approach to guideline-directed medical therapy optimization for heart failure: A real-world application to recovery

• Published in: American heart journal plus Vol. 45; p. 100438
• Main Authors: Yan, Crystal Lihong, Snipelisky, David, Velez, Mauricio, Baran, David, Estep, Jerry D., Bauerlein, E. Joseph, Thakkar Rivera, Nina
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2024; Elsevier
• Subjects: Guideline-directed medical therapy; Heart failure; Protocol; Reduced ejection fraction; Titration; Heart failure; Titration; Protocol; Guideline-directed medical therapy; Reduced ejection fraction
• ISSN: 2666-6022; 2666-6022
• DOI: 10.1016/j.ahjo.2024.100438

The objective of our study was to evaluate the real-world effects of an aggressive, personalized protocol for guideline-directed medical therapy (GDMT) titration in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We conducted a two-center retrospective cohort study. Patients with HFrEF who presented to a HF clinic from January 2020 to December 2022 were placed on a GDMT protocol. 180 patients were included in the study. Mean GDMT score significantly increased from 4.7 to 5.9 (p < 0.001) between initial and final visits. Mean left ventricular ejection fraction (LVEF) significantly increased from 28 % to 33 % (+5 %, p < 0.001). 27 (15.7 %) of the 172 patients with complete New York Heart Association (NYHA) classification data had improvement by at least 1 class, while 2 (1.2 %) patients had worsening NYHA classification. 140 (77.8 %) patients had no unplanned hospitalizations between visits. 21 (11.7 %) patients had an unplanned hospitalization for acute HF during the study period with a mean time from first clinic visit to hospitalization of 183 days (range: 13–821 days). 2 (1.1 %) patients were hospitalized due to GDMT-associated adverse drug events (i.e. hypotension, hyperkalemia). 7 (3.9 %) patients died during the study period, which was lower than the predicted 1-year death rate for our cohort (12.3 %) using the MAGGIC score. In conclusion, an aggressive, personalized protocol for GDMT titration in patients with HFrEF led to significant improvements in LVEF, NYHA classification, hospitalization, and mortality in a real-world setting. This protocol may help serve as a road map to lessen the gap between clinical knowledge and practice surrounding optimization of GDMT and move HFrEF patients toward a path to recovery.