Sykora Daniel, Olson Nicole, Churchill Robert, Kim B Michelle, Bratcher Melanie, Elwazir Mohamed, Young Kathleen, Ryan Sami, Brodin Michelle, Anderson Jan, Saunders Jeremiah, Abou Ezzeddine Omar, Bois John, Giudicessi John, Cooper Leslie, Rosenbaum Andrew
Mayo Clinic School of Graduate Medical Education Rochester MN.
Department of Pharmacy Mayo Clinic Rochester Rochester MN.
J Am Heart Assoc. 2024 Dec 17;13(24):e038965. doi: 10.1161/JAHA.124.038965. Epub 2024 Dec 14.
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.
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).
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.
多学科方法可改善收缩性心力衰竭（HF）的指南导向药物治疗，但该方法在心脏结节病所致HF患者中的疗效尚无报道。
在一项回顾性队列研究中，我们回顾了来自我院心脏结节病门诊的848例患者，确定那些诊断为心脏结节病、在首次评估时患有HF（左心室射血分数<50%）且在90天内及11至36个月内有超声心动图检查结果的患者。患者按是否参与由药剂师主导的药物治疗管理（MTM）计划进行分层，该计划旨在优化指南导向的药物治疗（MTM组与非MTM组[NMTM]），未进行随机分组。评估患者的人口统计学特征、左心室射血分数、指南导向的药物治疗（通过堪萨斯城医学优化评分量化）以及免疫抑制治疗情况。主要结局包括堪萨斯城医学优化评分的变化、左心室射血分数以及无心血管事件生存期（计划外HF住院、左心室辅助装置/心脏移植或死亡）。最终队列包括111例患者（中位年龄57岁；34%为女性；64%为纽约心脏协会I-II级）；43例（39%）为MTM组，68例（61%）为NMTM组。在首次评估时，两组的堪萨斯城医学优化评分均值相似（MTM组为23.2；NMTM组为29.6；P = 0.83）。在随访时（中位时间16个月），两组的堪萨斯城医学优化评分均显著升高（MTM组从23.2升至74.8；P<0.001；NMTM组从29.6升至58.7；P<0.001），但MTM组更高（P = 0.001）。MTM组的平均左心室射血分数有升高趋势（44.4%对40.0%，P = 0.05）。主要临床结局发生在1例MTM组患者（2.3%）和16例NMTM组患者（23.5%）中，NMTM组风险更高（风险比为11.97[95%CI，1.58 - 90.54]；P = 0.002）。
在这项回顾性队列研究中，由药剂师主导的MTM计划与心脏结节病合并HF患者的指南导向药物治疗优化良好以及不良心血管结局风险较低相关。
