Heart Failure Quadruple Therapy: Interdisciplinary Team Quality Improvement Initiative.

To improve heart failure quadruple therapy implementation and adherence at a large urban academic medical center. Heart failure (HF) affects over 6 million Americans and remains a burden on many US health care systems with rising cost. Despite strong evidence supporting the use of life saving medical therapy for HF with reduced ejection fraction (HFrEF), gaps persist in implementation. At a large urban academic medical center, strategies were targeted to increase the adherence and utilization of guideline directed medical therapy (GDMT) based on the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. An interdisciplinary team including advanced heart failure physicians and APPs, general cardiologists, the readmission engagement, and care transition (REACT) service, hospitalists, residents, fellows, social workers, nurses, and pharmacy was established. A HF risk score was developed in the electronic medical record to identify hospitalized patients with HF. HF quadruple medical therapy (beta blockers, mineralocorticoid receptors antagonist (MRAs), renin-angiotensin-aldosterone system (RAAS) inhibition, SGLT2i) was initiated in tandem with pharmacy support to assist with prior authorizations, monitoring for safety, and inpatient prior authorization to identify coverage barriers. Sodium-glucose contransporter-2 inhibitor (SGLT2i) was also added to the inpatient formulary. After hospital discharge a Care transition program consisting of case management, HF social workers, patient navigators, and advanced practice providers (APPs) provided care transition calls and follow up visits. To continue optimization and utilization of HF medical therapy an outpatient best practice advisory (BPA) reminded providers to start or increase HF GDMT. The hospital discharged 472 patients in 2020, 985 patients in 2021 and 578 patients with HF between Jan. -Aug. 2022. 48.6% of patients had a reduced ejection fraction (EF). HF Quadruple therapy medication inpatient prescribing showed an improvement from 6.7% in 2020 to 61.8% in 2022. SGLT2i at discharge also had an improvement in utilization from 3.4% in 2020 to 80% in 2022. The use of quadruple therapy was tracked over 30 days, 60.9% of patients remained on quadruple medication therapy. The results show an 822% improvement in adherence of quadruple medication therapy from 2022 to 2022. There was a 2,250% improvement in SGLT2i prescribing at discharge from 2020 to 2022. Overall heart failure 30-day readmission rate showed an improvement with 20.72% rate in 2020 to 17.2% in 2022. Implementation and optimization of GDMT in HF patients requires a multidisciplinary team approach. Pharmacy involvement and access to medications on inpatient formulary are critical for initiation and increasing medication compliance. Identifying patients with HF and having a dedicated team to ensure close follow up is essential in optimizing HF GDMT and reducing readmissions. In addition, the use of a HF BPA in outpatient clinics can further improve HF best practices. [ABSTRACT FROM AUTHOR]