Original Research
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Introduction:
Rapid initiation and titration of heart failure with reduced ejection fraction (HFrEF) guideline directed medical therapy (GDMT) may increase the risk of adverse events. The best approach for initiation and tolerability of the 4 pillars of GDMT in newly diagnosed HFrEF remains unclear.
Research Question or Hypothesis:
Newly diagnosed patients with HFrEF simultaneously initiated on all 4 pillars of GDMT prior to hospital discharge have higher rates of intolerance than less aggressive initiation strategies.
Study Design:
Single center, retrospective study.
Methods:
The study included adult patients admitted between May 2021 and September 2022 with newly diagnosed HFrEF initiated on GDMT. The primary outcome compared a composite safety outcome composed of hypotension, bradycardia, dizziness, fatigue, acute kidney injury, and elevated potassium between patients initiated on all 4 GDMT medications during the index hospitalization versus patients initiated on 3 medications or less at 1 and 3 months. Secondary outcomes included the percentage of patients on all 4 GDMT medications at 3 months and the number of hospitalizations due to heart failure exacerbations compared between the groups.
Results:
Of the 34 patients included, 18 (52.9%) received a 4 drug regimen and 16 (47.1%) received 3 or less GDMT medications prior to hospital discharge. There was no significant difference in the composite safety outcome at 1 month between groups (31.6% vs 26.7%, p = 1). Of 23 patients with available data at 3 months, patients on 3 or less medications at initial hospital discharge were less likely to be on all 4 pillars by 3 months (63.6% vs 0%, p= 0.001). The percentage of hospitalizations due to heart failure exacerbations at 3 months were similar between groups.
Conclusion:
In patients with newly diagnosed HFrEF, initiation of all 4 pillars of GDMT by the time of hospital discharge have similar rates of safety events compared to patients initiated on 3 or less medications.
Presenting Author
Rachel Sickley PharmDUniversity of Illinois Chicago College of Pharmacy
Authors
Vicki L. Groo PharmD, BCCP, CHC
University of Illinois at Chicago
Erika Hellenbart PharmD, BCPS
University of Illinois at Chicago College of Pharmacy
Robert J. DiDomenico PharmD, FCCP, FHFSA, FACC
University of Illinois at Chicago College of Pharmacy
Stephanie Dwyer Kaluzna PharmD, BCCP
University of Illinois Chicago