2025 Southeastern Residency Conference

Title: Pillars of Care: Impact of a Heart Failure Pharmacist on Optimization of Guideline Directed Medical Therapy


Authors: Christopher J. Rogers, Lindsey Pitt, Laura Bullock, Muddassir Mehmood 


Objective: Evaluate the impact clinical pharmacists have on titrating guideline directed medical therapy and their benefits to health systems.


Self Assessment Question: True of False: Heart failure pharmacists have a stastistically significant impact on up-titrating guideline directed medical therapy. 


Background: Heart failure currently impacts 6.2 million adults in the United States. The national 30-day and 90-day composite heart failure hospitalizations and emergency department visits rates are 18.2% and 31.2% respectively. Studies such as CHAMP-HF, EVOLUTION-HF, and GUIDE-IT trials have highlighted barriers in up-titrating and fulling implementing heart failure guideline directed medical therapy (GDMT). These barriers include bradycardia, hypotension, and declining renal function. A simple GDMT score was created to account for medication titration and additional factors that affect fully implementing heart failure guideline directed medical therapy. The purpose of this study was to determine and assess the impact of a heart failure clinical pharmacist on guideline directed medical therapy. 


Methods: This study was a single-center, retrospective, cohort, chart review that enrolled patients from January 2023 through August 2024. Patients were included in this study at least 18 years of age or older with a diagnosis of heart failure with reduced ejection fraction and completed at least one pharmacist-led titration visit within the study time frame. Patients were excluded if they were less than 18 years old or if they passed within the study time frame. The primary outcome was the change in the baseline GDMT score by at least one point 90-days after the first pharmacist-led GDMT titration visit. Secondary Endpoints included the change in the patient’s baseline GDMT score 120-days after the titration visit, combined 30-day and 90-day heart failure related hospitalizations and emergency department visits, and the revenue generated for the health system by pharmacist billing. The primary outcome was analyzed via the Chi-Square Goodness-of Fit analysis. All secondary outcomes were analyzed using descriptive statistics.  


Results: A total of n=100 patients were included in this study. The average patient was a Caucasian, male, with Medicare insurance, and NYHA class II symptoms at the time of the pharmacist-led titration visit. Common comorbid disease states included atrial fibrillation (43%), cardiomyopathy (60%), coronary artery disease (46%), and hypertension (55%). For the primary endpoint, 10 patients were expected to have a GDMT score increase, and 90 patients were expected to not have a GDMT score increase. 45 patients were observed to have a GDMT score increase while 55 patients were observed to not have a GDMT score increase (Chi-Square 136.11 p<0.001). At 120-days post titration visit, 7% patient’s scores increased, 71%patient’s scores remained the same, 3% of patients declined titrations, 11% of patients were lost to follow-up, and 7% of patients had scores decrease. 10% of patients were readmitted to the hospital or visited an emergency department for heart failure related causes within 30-days of the pharmacist-led titration visit. 11% of patients were hospitalized for heart failure and 14% of patients visited an emergency department within 90-days of the pharmacist-led titration visit. The total revenue generated for the health system by billing 99211 was $893.88.


Conclusion: Pharmacist-led GDMT titration visits had a statistically significant impact on increasing patient’s heart failure GDMT scores within our institution. This study also saw lower 30-day and 90-day rates for hospitalizations and emergency department visits for heart failure. While unable to completely justify a full pharmacist’s salary in the outpatient setting, our study demonstrated the ability for pharmacists to generate revenue for our health system.