Pharmacist Medication Titration Program for Patients With Cardiac Sarcoidosis and Systolic Heart Failure: A Retrospective Cohort Study.

BACKGROUND

A multidisciplinary approach improves guideline-directed medical therapy in systolic heart failure (HF), but its efficacy in patients with HF due to cardiac sarcoidosis is unreported.

METHODS AND RESULTS

In a retrospective cohort study, we reviewed 848 patients from our institutional cardiac sarcoidosis clinics, identifying those with a cardiac sarcoidosis diagnosis, HF (left ventricular ejection fraction <50%) at index evaluation, and echocardiograms within 90 days and 11 to 36 months. Patients were stratified by participation in a pharmacist-led medication therapy management (MTM) program for guideline-directed medical therapy optimization (MTM versus non-MTM [NMTM]) without randomization. Demographics, left ventricular ejection fraction, guideline-directed medical therapy (quantified by Kansas City Medical Optimization score), and immunosuppressive therapy were assessed. Primary outcomes included changes in Kansas City Medical Optimization score, left ventricular ejection fraction, and cardiovascular event-free survival (unplanned HF hospitalization, left ventricular assist device /heart transplant, or death). The final cohort included 111 patients (median age, 57 years; 34% women; 64% New York Heart Association class I-II); 43 (39%) were MTM and 68 (61%) were NMTM. Mean Kansas City Medical Optimization score was similar at index evaluation (MTM, 23.2; NMTM, 29.6; =0.83). At follow-up (median, 16 months), the Kansas City Medical Optimization score increased significantly in both groups (MTM, 23.2 to 74.8; <0.001; NMTM, 29.6 to 58.7; <0.001) but was higher in MTM (=0.001). Mean left ventricular ejection fraction trended toward higher values in MTM (44.4% versus 40.0%, =0.05). The primary clinical outcome occurred in 1 MTM (2.3%) and 16 NMTM (23.5%) patients, with higher risk in NMTM (hazard ratio, 11.97 [95% CI, 1.58-90.54]; =0.002).

CONCLUSIONS

In this retrospective cohort study, a pharmacist-led MTM program was associated with favorable guideline-directed medical therapy optimization and lower risk of adverse cardiovascular outcomes in patients with cardiac sarcoidosis with HF.