Evaluating Medication Optimization in Heart Failure: A Pharmacist’s Perspective


  • Dr. Leah M. Rappsilber
  • Jeremy Johnson Southwestern Oklahoma State University College of Pharmacy
  • Dr. Timothy L. Murray
  • Dr. Erica E. Martin
  • Dr. David M. Wilkett



This study is a multidisciplinary quality improvement initiative which aims to evaluate the appropriateness of physician-led care in the initiation of guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF) within the Oklahoma State University Medical Center (OSUMC) Cardiology Clinic.


A retrospective chart review was conducted for physician-managed patients enrolled in the clinic during the 6 months prior to establishment of pharmacist-led services. Participants included English-speaking adults who had a diagnosis of HFrEF documented by an echocardiogram, were patients at the OSUMC clinic, or were recently discharged from the OSUMC emergency department or inpatient services for new onset HFrEF or acute exacerbation. Data were analyzed to identify the proportion of patients on appropriate GDMT.


A total of 86.3% of patients were appropriately initiated on an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or angiotensin receptor blocker/neprilysin inhibitor, with 62.3% of those patients achieving optimal doses. A total of 95.0% of patients were appropriately initiated on beta blockers, with 71.1% of those patients achieving optimal doses. A total of 54.4% of patients with a LVEF ≤ 40% and an indication for an aldosterone antagonist also prescribed spironolactone; 96.8% of these patients achieved optimal doses.


While the majority of patients were appropriately initiated on GDMT, there is additional need for further titration of GDMT, initiation of indicated supplemental GDMT, and patient education. Further study on the benefit of multidisciplinary practice with the recent implementation of a pharmacist-managed HF service is recommended.