Abstract

Background: Guidelines from the American College of Cardiology and the American Heart Association (ACC/AHA) specify the pharmacological management of patients with heart failure with reduced ejection fraction (HFrEF). Many heart failure registries show suboptimal use of recommended medications in clinical practice, especially in rural communities. Without novel approaches to improve prescribing and guideline adherence, the benefits of HFrEF treatments will be unrealized. The purpose of this project is to increase the adherence rate of adult patients with HF to existing guidelines by implementing the ACC/AHA HF practice guidelines for HFrEF in a rural health clinic in south Alabama.

Design: A team of nurse practitioners and osteopathic medical students contacted the project participants via telephone to adjust their beta blockers and/or renin angiotensin system blockers to the treatment algorithm. The medications were titrated biweekly, and surveillance of blood pressure, pulse, and symptoms were conducted every Monday, Wednesday, and Friday. Outcomes measured included percent of participants optimized to guideline directed therapies and overall health status.

Results: 16 patients with HFrEF were offered optimization of beta blockers and/or ACE-I/ARB/ARNIs, 7 of the 16 agreed to participate, and 5 of the 7 completed the project. 5 of 5 patients were both optimized to guideline directed therapies for both beta blockers and ACE-I/ARB/ARNIs and showed an improvement in their overall health status as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ).
 

Conclusions: This supports the use of multidisciplinary teams to attain greater adherence to evidence-based pharmacological management in patients with HFrEF living in rural areas.