{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T18:38:32Z","timestamp":1773859112344,"version":"3.50.1"},"reference-count":0,"publisher":"Canadian Society of Healthcare-Systems Pharmacy","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJHP"],"abstract":"<jats:p>Background: Pharmacotherapy is the cornerstone of treatment for heart failure with reduced ejection fraction (HFrEF). The Canadian Cardiovascular Society and Canadian Heart Failure Society have defined guideline-directed medical therapy (GDMT) as 4 foundational medications. Despite strong recommendations for use of GDMT in HFrEF, current practice alignment with guidelines is unknown.\nObjectives: The primary objectives were to determine the proportion of patients for whom optimized GDMT for HFrEF was prescribed, to describe the doses of foundational medications achieved, and to describe any documented rationale limiting the optimization of GDMT. The secondary objectives were to describe documented pharmacist activities outside of scheduled multidisciplinary appointments at the heart function clinic (HFC) and to describe heart failure\u2013related hospital encounters in 2021.\nMethods: A retrospective cohort study using medical records of patients with HFrEF who were receiving treatment at the Regina HFC as of December 31, 2021, was conducted.\nResults: Of the 129 patients included in the study, 61 (47.3%) were prescribed optimized GDMT. Specifically, within the individual foundational medication classes, 82.2% (106\/129), 80.6% (104\/129), 79.1% (102\/129), and 74.4% (96\/129) of patients received optimized therapy with a renin\u2013 angiotensin system inhibitor, mineralocorticoid receptor antagonist, \u03b2-blocker, and sodium\u2013glucose cotransporter 2 inhibitor, respectively. Documented rationale was not available in 35.8% (38\/106) of instances of suboptimal utilization of GDMT and in 41.7% (60\/144) of instances of suboptimal dosing of GDMT. The most common documented rationale for suboptimal utilization was intolerance to the medication (33.0% [35\/106]), and the most common rationale for suboptimal dosing was intolerance to dose increases (57.6% [83\/144]). Pharmacists documented a total of 553 patient care activities for 58.9% (76\/129) of the patients, outside scheduled multidisciplinary appointments in the HFC. Sixteen patients (12.4%) had heart failure\u2013related hospital encounters a total of 31 times in 2021.\nConclusions: Although many patients were receiving the benefits of multidisciplinary care at the Regina HFC, there remained a treatment gap in the use of GDMT for HFrEF. These findings will be used to inform strategies to improve clinic processes, including efficient identification of patients requiring optimization of GDMT, who would benefit the most from multidisciplinary care.\nKeywords: heart failure with reduced ejection fraction, guideline-directed medical therapy, heart function clinic, multidisciplinary clinic, pharmacist activities, hospitalization\nR\u00c9SUM\u00c9\nContexte : La pharmacoth\u00e9rapie est la pierre angulaire du traitement de l\u2019insuffisance cardiaque avec fraction d\u2019\u00e9jection r\u00e9duite (ICFEr). La Soci\u00e9t\u00e9 cardiovasculaire du Canada et la Soci\u00e9t\u00e9 canadienne d\u2019insuffisance cardiaque ont d\u00e9fini le traitement m\u00e9dical fond\u00e9 sur les lignes directrices (TMFLD) selon 4 m\u00e9dicaments fondamentaux. Malgr\u00e9 de fortes recommandations pour l\u2019utilisation du TMFLD dans l\u2019ICFEr, l\u2019alignement actuel de la pratique sur les lignes directrices est inconnu.\nObjectifs : Les objectifs principaux \u00e9taient de d\u00e9terminer la proportion de patients pour lesquels un TMFLD optimis\u00e9 pour l\u2019ICFEr avait \u00e9t\u00e9 prescrit, de d\u00e9crire les doses obtenues et de d\u00e9crire les justifications document\u00e9es limitant l\u2019optimisation du TMFLD. Les objectifs secondaires, quant \u00e0 eux, \u00e9taient de d\u00e9crire les activit\u00e9s document\u00e9es du pharmacien en dehors des rendez-vous pr\u00e9vus \u00e0 la clinique multidisciplinaire de fonction cardiaque et de recenser les consultations hospitali\u00e8res li\u00e9es \u00e0 l\u2019insuffisance cardiaque au cours de l\u2019ann\u00e9e civile 2021.\nM\u00e9thodes : Cette \u00e9tude de cohorte r\u00e9trospective se basait sur les dossiers m\u00e9dicaux de patients atteints d\u2019ICFEr qui recevaient un traitement \u00e0 la clinique de fonction cardiaque de Regina au 31 d\u00e9cembre 2021.\nR\u00e9sultats : Sur les 129 patients inclus dans l\u2019\u00e9tude, 61 d\u2019entre eux (47,3 %) ont re\u00e7u un TMFLD optimis\u00e9. Plus pr\u00e9cis\u00e9ment, en ce qui concerne les classes de m\u00e9dicaments fondamentaux, 82,2 % (106\/129) ont re\u00e7u un traitement optimal avec un inhibiteur du syst\u00e8me r\u00e9nine-angiotensine, 80,6 % (104\/129) avec un antagoniste des r\u00e9cepteurs min\u00e9ralocortico\u00efdes, 79,1 % (102\/129) avec un \u03b2-bloquant et 74,4 % (96\/129) avec un inhibiteur sodique du cotransporteur de glucose 2. Dans 35,8 % (38\/106) des cas d\u2019utilisation sous-optimale du TMFLD et dans 41,7 % (60\/144) des cas de dosage sous-optimal de celui-ci, la justification document\u00e9e \u00e9tait indisponible. Lorsqu\u2019elles \u00e9taient document\u00e9es, les justifications les plus courantes \u00e9taient l\u2019intol\u00e9rance, respectivement, \u00e0 l\u2019utilisation d\u2019un m\u00e9dicament (33.0% [35\/106]) et \u00e0 l\u2019augmentation de la dose (57,6 % [83\/144]). Les pharmaciens ont consign\u00e9 un total de 553 activit\u00e9s de soins aux patients pour 58,9 % (76\/129) des patients en dehors des rendez-vous multidisciplinaires pr\u00e9vus dans la clinique de fonction cardiaque. Seize (12,4 %) des patients ont \u00e9t\u00e9 hospitalis\u00e9s pour une insuffisance cardiaque 31 fois au total en 2021.\nConclusion : Bien que de nombreux patients b\u00e9n\u00e9ficiaient des soins multidisciplinaires \u00e0 la clinique de fonction cardiaque de Regina, une lacune subsistait dans le traitement par rapport \u00e0 l\u2019utilisation du TMFLD pour l\u2019ICFEr. Ces r\u00e9sultats seront utilis\u00e9s pour \u00e9clairer les strat\u00e9gies visant \u00e0 am\u00e9liorer les processus cliniques, y compris l\u2019identification efficace des patients n\u00e9cessitant une optimisation du TMFLD, qui b\u00e9n\u00e9ficieraient le plus de soins multidisciplinaires.\nMots-cl\u00e9s : insuffisance cardiaque avec fraction d\u2019\u00e9jection r\u00e9duite, traitement m\u00e9dical fond\u00e9 sur les lignes directrices, clinique de la fonction cardiaque, clinique multidisciplinaire, activit\u00e9s du pharmacien, hospitalisation<\/jats:p>","DOI":"10.4212\/cjhp.3373","type":"journal-article","created":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T17:31:35Z","timestamp":1710351095000},"source":"Crossref","is-referenced-by-count":2,"title":["Evaluation of Guideline-Directed Medical Therapy for Outpatients Living with Heart Failure with Reduced Ejection Fraction"],"prefix":"10.4212","volume":"77","author":[{"given":"Taylor","family":"McVannel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lori","family":"Albers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynette","family":"Kosar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brittani","family":"Reid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colin","family":"Yeung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad","family":"Siddiqui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oleksandr","family":"Baran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2732","published-online":{"date-parts":[[2024,3,13]]},"container-title":["Canadian Journal of Hospital Pharmacy"],"original-title":[],"link":[{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3373\/5228","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3373\/5235","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3373\/5228","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T17:31:35Z","timestamp":1710351095000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/view\/3373"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,13]]},"references-count":0,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,10]]}},"URL":"https:\/\/doi.org\/10.4212\/cjhp.3373","relation":{},"ISSN":["1920-2903","0008-4123"],"issn-type":[{"value":"1920-2903","type":"electronic"},{"value":"0008-4123","type":"print"}],"subject":[],"published":{"date-parts":[[2024,3,13]]}}}