2025 Southeastern Residency Conference

Title: 
The gaps in guideline-directed medical therapy associated with 30-day readmission in patients with heart failure

Author:
Teya Klein, PharmD
PGY1 Pharmacy Resident
St. Joseph’s/Candler
Kleintey@sjchs.org
Co-Investigators: 
Ashley G. Woodhouse, PharmD. BCACP, CDTM
David Yi, Pharmacist candidate 2025

Objective: This research project aims to investigate the gaps in guideline-directed medical therapy for patients with heart failure that have been readmitted to St. Joseph’s/Candler hospital within 30 days and their utilization of a follow up outpatient appointment prior to readmission.
Background: 
             Heart failure poses a major public health challenge, marked by high morbidity, mortality, and healthcare costs. Hospital readmissions remain common despite advancements in guideline-directed medical therapy (GDMT)1,2. Key GDMT agents include Angiotensin converting enzyme inhibitors, Angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists, Sodium-glucose cotransforter-2 (HFpEF) and mildly reduced ejection fraction (HFmrEF)3. CMS initiatives emphasize follow-up care to improve GDMT adherence and reduce readmissions. This study explores these factors to enhance patient outcomes and inform heart failure care practices.
Methods: 
This single-center, retrospective study analyzed heart failure (HF) patients readmitted to St. Joseph’s/Candler (SJ/C) hospital within 30 days between December 1, 2023, and June 30, 2024. Chart reviews identified adult patients using ICD-10 codes and examined their utilization of follow-up outpatient care before readmission. Records were reviewed to determine if patients attended a transition of care (TOC) visit at an SJ/C location, including hospital/provider calls and visits with primary care or cardiologists or displayed gaps in GDMT. Medication regimens were evaluated for gaps in GDMT for patients with heart failure at TOC if applicable and prior to readmission.
Results: 
Among the 116-heart failure patients readmitted within 30 days, 28 (24.1%) had a transition of care appointment, while 88 (75.9%) did not. Of those who had a transition of care appointment, 12 were within the hospital network, 16 were outside the network, and only 6 had no gaps in guideline-directed medical therapy. Among the 88 patients without a transition of care call only 5 were within the network. The primary endpoint analysis showed no statistically significant association between transition of care follow-up and if patients were on GDMT or not, with a p-value of 0.88. For the secondary outcome, pharmacist-led TOC calls were associated with better GDMT adherence. 7 patients received a transition of care call from a pharmacist, and all were on appropriate guideline-directed medical therapy. However, all 7 patients were still readmitted within 30 days. The reasons for readmission among these patients were hypoxia (4), hypotension (1), shingles outbreak (1), and cerebrovascular accident (1), suggesting that factors beyond guideline-directed medical therapy adherence contributed to their readmission.
Conclusions: 
This study found no statistically significant relationship between TOC follow-up, GDMT adherence, and 30-day readmission rates in heart failure patients. While gaps in GDMT were common, particularly among those without TOC follow-ups, the lack of statistical significance suggests that other factors may contribute to readmission. The secondary outcome highlights that even patients with pharmacist-led TOC calls and no GDMT gaps experienced readmission, often due to non-cardiac causes. These findings suggest that optimizing GDMT alone may not be sufficient to reduce readmissions, and a more comprehensive approach addressing other clinical and social factors may be necessary.