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Pharmacy and Pharmaceutical Sciences
Evaluation of Guideline-Directed Medication Therapy for Heart Failure with Reduced Ejection Fraction Patients at Discharge on 30-Day Readmission Rates at Two Tertiary Healthcare Centers
Principal Investigator: Jacqueline Hesse, Pharm.D.
Preceptors: Yan Xu, Pharm.D., BCPS, BCCP; Meri Slavica, Ph.D., BCPS
Pharmacy Student: James Watkins, 2020 Pharm.D. Candidate
Sub-Investigators: Alan Rankin, MD; Joshua Remick, MD
Heart failure with reduced ejection fraction (HFrEF) is a chronic, progressive disease leading to symptoms such as dyspnea, cough, edema, fatigue, and exercise intolerance. The use of anangiotensin converting enzyme inhibitor (ACEi), angiotensin II receptor blocker (ARB), or angiotensin receptor-neprilysin inhibitor (ARNI) in combination with an evidence-based beta blocker (BB) is guideline-supported Class I recommended therapy for HFrEF with an LVEF
A retrospective chart review was completed using the Epic Electronic Medical Record of all patients admitted to one of our tertiary medical centers between January 1, 2018 and December 31, 2019 with a primary diagnosis of HFrEF. Patients were included if they were at least 18 years of age and had an LVEF of
A total of 1,999 patient admissions underwent chart review with 752 admissions not meeting inclusion criteria and 1,247 admissions being included in the final analysis. Of those included, 202 patients (16%) were readmitted within 30 days. Patients discharged with any GDMT had less readmissions within 30 days than those without any GDMT (OR 0.6, 95% CI 0.4-1.0, p = 0.0369). However, patients discharged on an ACEi or ARB had more readmissions within 30 days than patients discharged on no GDMT (OR 1.4, 95% CI 1.0-1.9, p = 0.0283). 49% of patients (N = 609) had an idiopathic cause of heart failure followed by 32% of patients with non-ischemic cardiomyopathy (N = 394) and 20% of patients with ischemic cardiomyopathy (N = 244). No significant differences were found between the 30-day readmission rate and cause of heart failure. For highest K value on readmission, no significant differences were found between groups. For highest SCr on readmission, discharging on an ACEi or ARB or discharging on an ACEi or ARB in combination with a BB yielded a significantly lower SCr on readmission compared to no GDMT (1.6 vs. 2.6, p =
In conclusion, patients admitted with a primary diagnosis of HFrEF that are discharged on any GDMT were found to have less readmissions for any reason within 30 days than those without any GDMT. However, subgroup analysis for individual GDMT may not have a lower rate of readmissions. Further research with prospective randomized controlled trials is needed to determine statistical significance of subgroups of GDMT on the rate of readmission within 30 days.
Graduate Medical Education
Conference / Event Name
Academic Achievement Day, 2020
Providence St. Vincent, PGY-1 Pharmacy Residency Program
Hesse, Jacqueline; Xu, Yan; Slavica, Meri; Watkins, James E.; Rankin, Alan; and Remick, Joshua, "Evaluation of Guideline-Directed Medication Therapy for Heart Failure with Reduced Ejection Fraction Patients at Discharge on 30-Day Readmission Rates at Two Tertiary Healthcare Centers" (2020). Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers. 4.