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Previous literature signals low rates of guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF). Hyperkalemia may preclude renin-angiotensin-system (RAS) inhibitors and aldosterone antagonists (AA) prescribing. Clinical pharmacists (CP) are integral care team members that can facilitate safe use of novel potassium binders and improve practice adoption to overcome this barrier to GDMT.
This study evaluated the impact of patiromer on GDMT prescribing patterns within a multidisciplinary clinic. A collaborative agreement between a CP and HF specialist allowed for drug initiation and titration. The primary outcome was percent of patients receiving GDMT after 6 months of patiromer therapy. Secondary outcomes included EF, NT-proBNP and GDMT dose.
A total of 17 patients were included. Mean pre-patiromer potassium was 5.4 mEq/L and mean serum creatinine was 2.3 mg/dL. Patiromer was well tolerated and zero patients discontinued drug. Mean post-patiromer potassium decreased to 4.7 mEq/L. RAS inhibitor and AA utilization increased significantly from 70.6% to 100% and 11.8% to 64.7% respectively. Secondary outcomes are illustrated in Table 1.
CP-driven initiation of patiromer subsequently improved GDMT prescribing and dose titration. Using a multidisciplinary approach and CP-physician collaborative practice is critical in the care of patients with heart failure.
|Daily ACE inhibitor dose (mg enalapril equivalents)||13.3||18.1|
|Daily ARB dose (mg valsartan equivalents)||80||200|
|Daily ARNI dose (mg valsartan equivalents)||52||120.7|
|Daily AA dose (mg spironolactone equivalents)||18.8||22.5|
Moderated Poster Contributions
Spotlight on Special Topics Moderated Poster Theater, Posters, Hall A
Saturday, March 28, 2020, 1:00 p.m.-1:10 p.m.
Session Title: Team-Based Approaches to Patient Care
Presentation Number: 1098-05
- 2020 American College of Cardiology Foundation