Efficacy of an Algorithm for Guideline-directed Medical Therapy Optimization in Heart Failure with Reduced Ejection Fraction

Heart failure with reduced ejection fraction (HFrEF) is associated with high morbidity, mortality, and healthcare expenditures. Guideline-directed medical therapy (GDMT) is an effective but underutilized treatment of HFrEF. Evidence-based strategies to facilitate GDMT optimization and improve patient outcomes are essential. This quality improvement (QI) project aimed to apply a standardized algorithm to enhance GDMT titration among HFrEF patients. The project employed an interventional-prospective design to optimize GDMT for adult HFrEF patients through weekly telephone follow-ups over a three-month period. The project included 26 HFrEF patients, with the majority being white (92.3%) and male (57.7%). At the end of the project, nearly 77% of participants achieved GDMT optimization. The results demonstrated significant improvements in the dosages of angiotensin receptor-neprilysin inhibitors/angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors. There was no statistically significant increase in the dosage of beta-blockers. Barriers to optimization included medication cost, symptomatic hypotension, and patient preference. This project highlights the feasibility and effectiveness of a structured telehealth intervention in optimizing GDMT for HFrEF patients. The findings suggest that remote titration may be a viable strategy for improving medication adherence and patient outcomes.