Abstract

This study aims to evaluate the impact of pharmacist intervention on guideline-directed medical therapy (GDMT) utilization and dose optimization in heart failure with reduced ejection fraction (HFrEF) patients. A prospective pre–post intervention study was conducted at the Heart Failure Medication Therapy Adherence Clinic (HF-MTAC), Hospital Pulau Pinang, Malaysia, enrolling 70 HFrEF patients through convenience sampling. Each patient was followed up for 9 months, receiving pharmacist-led interventions, medication reviews, and collaborative therapeutic recommendations with physicians. GDMT utilization and dose optimization were evaluated at baseline and post-intervention using the McNemar test and Wilcoxon signed-rank test. Among 70 enrolled patients (median age: 59.5 years), 63 completed the study. Pharmacist intervention significantly increased the use of angiotensin receptor-neprilysin inhibitor (ARNI) (42.9% to 58.7%, p < 0.001), mineralocorticoid receptor antagonist (MRA) (73.0% to 90.5%, p = 0.007), and sodium–glucose cotransporter 2 (SGLT2) inhibitors (25.4% to 49.2%, p < 0.001). Quadruple GDMT use rose from 12.7% to 42.9% (p < 0.001). The proportion of patients achieving ≥50% target doses of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker/ARNI improved (31.7% to 63.9%, p < 0.001), while beta-blocker dose optimization increased (22.2% to 33.3%, p = 0.039). In conclusion, pharmacist intervention in HF-MTAC significantly improved GDMT utilization and dose optimization, particularly for ARNI, MRA, and SGLT2 inhibitors.

Key words: Heart failure, pharmacist intervention, guideline-directed medical therapy, dose optimization.