Alhashimi Lana, Cordwin David J, Guidi Jessica, Hummel Scott L, Koelling Todd M, Dorsch Michael P
College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA.
Medical School, University of Michigan, Ann Arbor, Michigan, USA.
J Am Coll Clin Pharm. 2024 Jul 23;2024. doi: 10.1002/jac5.2013.
Guideline-directed medical therapy (GDMT) has significantly improved outcomes in patients with heart failure with reduced ejection fraction (HFrEF). However, GDMT prescribing remains suboptimal. The purpose of this study was to survey cardiologists, internists, and pharmacists on their approach to GDMT prescribing.
A survey containing 20 clinical vignettes of patients with HFrEF was answered by 127 cardiologists, 68 internists, and 89 pharmacists. Each vignette presented options for adjusting GDMT. Responses were dichotomized to the answer of interest. A mixed-effect model was used to calculate the odds of changing GDMT between pharmacists and physicians.
Pharmacists were more likely to make changes to GDMT compared with internists (92.1% vs 82%; odds ratio [OR] 3.02 [1.50-6.06]; p=0.002). In medically-naïve patients, pharmacists were more likely to initiate beta-blockers than internists (45.4% vs 32.0%; OR 2.19 [1.00-4.79], p=0.049). Pharmacists were more likely than both internists and cardiologists to initiate mineralocorticoid receptor antagonists (34.4% vs 11.5%; OR 4.95 [2.41-10.18]; p<0.001 and 34.4% vs 13.9%; OR 3.95 [2.16-7.21]; p<0.001). Pharmacists were more likely than both internists and cardiologists to titrate beta-blockers (30.9% vs 16.4%; OR 3.15 [1.92-5.19]; p<0.001 and 30.9% vs 22.0%; OR 1.88 [0.18-2.87]; p=0.0030). Pharmacists were more likely than internists to titrate angiotensin receptor-neprilysin inhibitors (ARNI) (61.8% vs 34.1%; OR 3.54 [1.50-8.39]; p=0.004).
The survey results show pharmacists were more likely to make any adjustments to GDMT than internists and cardiologists. Pharmacists prefer adding spironolactone and titrating beta-blockers compared with cardiologists and internists. Compared with only internists, pharmacists were more likely to initiate beta-blockers and titrate the dose of ARNI.
指南指导的药物治疗（GDMT）显著改善了射血分数降低的心力衰竭（HFrEF）患者的预后。然而，GDMT的处方情况仍不理想。本研究的目的是就GDMT的处方方法对心脏病专家、内科医生和药剂师进行调查。
127名心脏病专家、68名内科医生和89名药剂师回答了一份包含20个HFrEF患者临床病例的调查问卷。每个病例都提供了调整GDMT的选项。回答被二分法化为感兴趣的答案。使用混合效应模型计算药剂师和医生之间改变GDMT的几率。
与内科医生相比，药剂师更有可能改变GDMT（92.1%对82%；优势比[OR]3.02[1.50 - 6.06]；p = 0.002）。在缺乏医学经验的患者中，药剂师比内科医生更有可能起始β受体阻滞剂（45.4%对32.0%；OR 2.19[1.00 - 4.79]，p = 0.049）。药剂师比内科医生和心脏病专家更有可能起始盐皮质激素受体拮抗剂（34.4%对11.5%；OR 4.95[2.41 - 10.18]；p < 0.001和34.4%对13.9%；OR 3.95[2.16 - 7.21]；p < 0.001）。药剂师比内科医生和心脏病专家更有可能滴定β受体阻滞剂（30.9%对16.4%；OR 3.15[1.92 - 5.19]；p < 0.001和30.9%对22.0%；OR 1.88[0.18 - 2.87]；p = 0.0030）。药剂师比内科医生更有可能滴定血管紧张素受体脑啡肽酶抑制剂（ARNI）（61.8%对34.1%；OR 3.54[1.50 - 8.39]；p = 0.004）。
调查结果显示，与内科医生和心脏病专家相比，药剂师更有可能对GDMT进行任何调整。与心脏病专家和内科医生相比，药剂师更喜欢添加螺内酯并滴定β受体阻滞剂。与仅内科医生相比，药剂师更有可能起始β受体阻滞剂并滴定ARNI的剂量。
