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Zheutlin AR. Overcoming clinical inertia to improve the use of cardiovascular risk reducing therapy: A Fellow's Voice. Am J Prev Cardiol 2024; 18:100671. [PMID: 38737853 PMCID: PMC11087899 DOI: 10.1016/j.ajpc.2024.100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Affiliation(s)
- Alexander R Zheutlin
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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2
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Zhang Z, Wang C, Tu T, Lin Q, Zhou J, Huang Y, Wu K, Zhang Z, Zuo W, Liu N, Xiao Y, Liu Q. Advancing Guideline-Directed Medical Therapy in Heart Failure: Overcoming Challenges and Maximizing Benefits. Am J Cardiovasc Drugs 2024; 24:329-342. [PMID: 38568400 PMCID: PMC11093832 DOI: 10.1007/s40256-024-00646-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 05/15/2024]
Abstract
The delayed titration of guideline-directed drug therapy (GDMT) is a complex event influenced by multiple factors that often result in poor prognosis for patients with heart failure (HF). Individualized adjustments in GDMT titration may be necessary based on patient characteristics, and every clinician is responsible for promptly initiating GDMT and titrating it appropriately within the patient's tolerance range. This review examines the current challenges in GDMT implementation and scrutinizes titration considerations within distinct subsets of HF patients, with the overarching goal of enhancing the adoption and effectiveness of GDMT. The authors also underscore the significance of establishing a novel management strategy that integrates cardiologists, nurse practitioners, pharmacists, and patients as a unified team that can contribute to the improved promotion and implementation of GDMT.
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Affiliation(s)
- Zixi Zhang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Changsha, 410011, Hunan Province, People's Republic of China
| | - Cancan Wang
- Department of Metabolic Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, People's Republic of China
| | - Tao Tu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Changsha, 410011, Hunan Province, People's Republic of China
| | - Qiuzhen Lin
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Changsha, 410011, Hunan Province, People's Republic of China
| | - Jiabao Zhou
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Changsha, 410011, Hunan Province, People's Republic of China
| | - Yunying Huang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Changsha, 410011, Hunan Province, People's Republic of China
| | - Keke Wu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Changsha, 410011, Hunan Province, People's Republic of China
| | - Zeying Zhang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Changsha, 410011, Hunan Province, People's Republic of China
| | - Wanyun Zuo
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, People's Republic of China
| | - Na Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Changsha, 410011, Hunan Province, People's Republic of China
| | - Yichao Xiao
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Changsha, 410011, Hunan Province, People's Republic of China.
| | - Qiming Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Changsha, 410011, Hunan Province, People's Republic of China.
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3
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Maddox TM, Januzzi JL, Allen LA, Breathett K, Brouse S, Butler J, Davis LL, Fonarow GC, Ibrahim NE, Lindenfeld J, Masoudi FA, Motiwala SR, Oliveros E, Walsh MN, Wasserman A, Yancy CW, Youmans QR. 2024 ACC Expert Consensus Decision Pathway for Treatment of Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2024; 83:1444-1488. [PMID: 38466244 DOI: 10.1016/j.jacc.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
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4
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Beavers CJ, Bhatt DL, Gotter G. Reply to 'The pharmacist ally in heart failure: Useful when involved'. Eur J Heart Fail 2024. [PMID: 38606515 DOI: 10.1002/ejhf.3242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 03/31/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
- Craig J Beavers
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gad Gotter
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Heart Initiative, Durham, NC, USA
- Universite Paris Cite, INSERM UMR-S 942 (MASCOT), Paris, France
- Momentum Research, Inc, Durham, NC, USA
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5
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Okumura T, Murohara T. Overcoming the Clinical Inertia behind Inadequate Adherence to Guideline-Directed Medical Therapy. Cardiology 2024; 149:225-227. [PMID: 38498984 DOI: 10.1159/000536504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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6
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Shaw L, Briscoe S, Nunns MP, Lawal HM, Melendez-Torres GJ, Turner M, Garside R, Thompson Coon J. What is the quantity, quality and type of systematic review evidence available to inform the optimal prescribing of statins and antihypertensives? A systematic umbrella review and evidence and gap map. BMJ Open 2024; 14:e072502. [PMID: 38401904 PMCID: PMC10895245 DOI: 10.1136/bmjopen-2023-072502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 01/31/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVES We aimed to map the systematic review evidence available to inform the optimal prescribing of statins and antihypertensive medication. DESIGN Systematic umbrella review and evidence and gap map (EGM). DATA SOURCES Eight bibliographic databases (Cochrane Database of Systematic Reviews, CINAHL, EMBASE, Health Management Information Consortium, MEDLINE ALL, PsycINFO, Conference Proceedings Citation Index-Science and Science Citation Index) were searched from 2010 to 11 August 2020. Update searches conducted in MEDLINE ALL 2 August 2022. We searched relevant websites and conducted backwards citation chasing. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We sought systematic reviews of quantitative or qualitative research where adults 16 years+ were currently receiving, or being considered for, a prescription of statin or antihypertensive medication. Eligibility criteria were applied to the title and abstract and full text of each article independently by two reviewers. DATA EXTRACTION AND SYNTHESIS Quality appraisal was completed by one reviewer and checked by a second. Review characteristics were tabulated and incorporated into an EGM based on a patient care pathway. Patients with lived experience provided feedback on our research questions and EGM. RESULTS Eighty reviews were included within the EGM. The highest quantity of evidence focused on evaluating interventions to promote patient adherence to antihypertensive medication. Key gaps included a lack of reviews synthesising evidence on experiences of specific interventions to promote patient adherence or improve prescribing practice. The evidence was predominantly of low quality, limiting confidence in the findings from individual reviews. CONCLUSIONS This EGM provides an interactive, accessible format for policy developers, service commissioners and clinicians to view the systematic review evidence available relevant to optimising the prescribing of statin and antihypertensive medication. To address the paucity of high-quality research, future reviews should be conducted and reported according to existing guidelines and address the evidence gaps identified above.
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Affiliation(s)
- Liz Shaw
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK
| | - Simon Briscoe
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK
| | - Michael P Nunns
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK
| | - Hassanat Mojirola Lawal
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK
| | - G J Melendez-Torres
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK
| | - Malcolm Turner
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK
- NIHR ARC South West Peninsula Patient and Public Engagement Group, University of Exeter, Exeter, UK
| | - Ruth Garside
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK
- European Centre for Environment and Health, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK
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7
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Heidenreich P. Heart failure management guidelines: New recommendations and implementation. J Cardiol 2024; 83:67-73. [PMID: 37949313 DOI: 10.1016/j.jjcc.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/07/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
The prevalence of heart failure has increased in many developed countries including Japan and the USA, due in large part to the aging of their populations. The lifetime risk of heart failure is now 20-30 % in the USA. Fortunately, there have been important advances in therapy that increase quality and length of life for those with heart failure. This review discusses the important advances in care including treatment and diagnosis and the new recommendations for this care from the recent American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Failure Society of America (HFSA) Guideline. Relevant studies that have been published since the guideline was released are also included. Of the many recommendations in the ACC/AHA/HFSA Guideline, this review focuses on the definition of heart failure, the medical treatments specific to left ventricular ejection fraction, use of devices for treatment and diagnosis, diagnosis and treatment of amyloidosis, treatment of iron deficiency, screening for asymptomatic left ventricular dysfunction, use of patient reported outcomes, and tools for implementation.
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Affiliation(s)
- Paul Heidenreich
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
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Harrington J, Rao VN, Leyva M, Oakes M, Mentz RJ, Bosworth HB, Pagidipati NJ. Improving Guideline-Directed Medical Therapy for Patients With Heart Failure With Reduced Ejection Fraction: A Review of Implementation Strategies. J Card Fail 2024; 30:376-390. [PMID: 38142886 DOI: 10.1016/j.cardfail.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/26/2023]
Abstract
Despite recent advances in the use of guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF), achievement of target GDMT use and up-titration to goal dosages continue to be modest. In recent years, a number of interventional approaches to improve the usage of GDMT have been published, but many are limited by single-center experiences with small sample sizes. However, strategies including the use of multidisciplinary teams, dedicated GDMT titration algorithms and clinician audits with feedback have shown promise. There remains a critical need for large, rigorous trials to assess the utility of differing interventions to improve the use and titration of GDMT in HFrEF. Here, we review existing literature in GDMT implementation for those with HFrEF and discuss future directions and considerations in the field.
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Affiliation(s)
- Josephine Harrington
- Department of Medicine, Division of Cardiology Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC.
| | - Vishal N Rao
- Department of Medicine, Division of Cardiology Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Monica Leyva
- Department of Population Health Sciences, Durham, NC
| | - Megan Oakes
- Department of Population Health Sciences, Durham, NC
| | - Robert J Mentz
- Department of Medicine, Division of Cardiology Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Hayden B Bosworth
- Department of Medicine, Division of Cardiology Duke University, Durham, NC; Department of Population Health Sciences, Durham, NC
| | - Neha J Pagidipati
- Department of Medicine, Division of Cardiology Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
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9
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Dedo R, Jurga T, Barkham J. VA Home Telehealth Program for Initiating and Optimizing Heart Failure Guideline-Directed Medical Therapy. Fed Pract 2023; 40:S16-S23. [PMID: 38812590 PMCID: PMC11132190 DOI: 10.12788/fp.0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Background Heart failure (HF) is a chronic, progressive medical condition. Evidence suggests that guideline-directed medical therapy improves both morbidity and mortality in patients with HF with reduced ejection fraction when properly optimized. Unfortunately, many patients do not receive optimized therapy, highlighting the need to optimize clinicians' methods to more effectively and efficiently initiate and titrate medical therapy. Methods This single-center, retrospective study evaluated the rates of drug interventions prompted by the home telehealth monitoring program for veterans with HF with reduced ejection fraction. Rates of drug interventions were evaluated among those who enrolled and those who did not enroll in the program. Results There were 20 drug-related interventions in the home telehealth group compared with 11 interventions for the control group. One HF-related hospitalization occurred in the home telehealth program group compared with 6 in the control group. Conclusions This study demonstrates the potential of home telehealth to optimize veterans' medication regimens and to reduce HF-related hospitalizations. It also provides an additional catalyst to further develop home telehealth services specifically targeted at drug therapy initiation and optimization in patients with HF with reduced ejection fraction.
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Affiliation(s)
- Robert Dedo
- Veterans Affairs Ann Arbor Healthcare System, Michigan
| | - Tomasz Jurga
- Veterans Affairs Ann Arbor Healthcare System, Michigan
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10
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Dixit NM, Parikh NU, Ziaeian B, Fonarow GC. Economic Modeling Analysis of an Intensive GDMT Optimization Program in Hospitalized Heart Failure Patients. Circ Heart Fail 2023; 16:e011218. [PMID: 37929591 PMCID: PMC10872946 DOI: 10.1161/circheartfailure.123.011218] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The STRONG-HF trial (Safety, Tolerability and Efficacy of Up-Titration of Guideline-Directed Medical Therapies for Acute Heart Failure) demonstrated substantial reductions in the composite of mortality and morbidity over 6 months among hospitalized patients with heart failure (HF) who were randomized to intensive guideline-directed medical therapy (GDMT) optimization compared with usual care. Whether an intensive GDMT optimization program would be cost-effective for patients with HF with reduced ejection fraction is unknown. METHODS Using a 2-state Markov model, we evaluated the effect of an intensive GDMT optimization program on hospitalized patients with HF with reduced ejection fraction. Two population models were created to simulate this intervention, a clinical trial model, based on the participants in the STRONG-HF trial, and a real-world model, based on the Get With The Guidelines-HF registry of patients admitted with worsening HF. We then modeled the effect of a 6-month intensive triple therapy GDMT optimization program comprised of cardiologists, clinical pharmacists, and registered nurses. Hazard ratios from the intervention arm of the STRONG-HF trial were applied to both population models to simulate clinical and financial outcomes of an intensive GDMT optimization program from a US health care sector perspective with a lifetime time horizon. Optimal quadruple GDMT use was also modeled. RESULTS An intensive GDMT optimization program was extremely cost-effective with incremental cost-effectiveness ratios <$10 000 per quality-adjusted life-year in both models. Optimal quadruple GDMT implementation resulted in the most gains in life-years with incremental cost-effectiveness ratios of $60 000 and $54 000 in the clinical trial and real-world models, respectively. CONCLUSIONS An intensive GDMT optimization program for patients hospitalized with HF with reduced ejection fraction would be cost-effective and result in substantial gains in clinical outcomes, especially with the use of optimal quadruple GDMT. Clinicians, payers, and policymakers should prioritize the creation of such programs.
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Affiliation(s)
- Neal M. Dixit
- Division of Cardiovascular Medicine, Department of Medicine, University of California, Davis, Sacramento, California
| | - Neil U. Parikh
- School of Medicine, Keck School of Medicine of USC, Los Angeles, CA
| | - Boback Ziaeian
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Division of Cardiology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Gregg C. Fonarow
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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11
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Glushkova N, Turdaliyeva B, Kulzhanov M, Karibayeva IK, Kamaliev M, Smailova D, Zhamakurova A, Namazbayeva Z, Mukasheva G, Kuanyshkalieva A, Otyzbayeva N, Semenova Y, Jobalayeva B. Examining disparities in cardiovascular disease prevention strategies and incidence rates between urban and rural populations: insights from Kazakhstan. Sci Rep 2023; 13:20917. [PMID: 38017260 PMCID: PMC10684854 DOI: 10.1038/s41598-023-47899-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
Kazakhstan is experiencing a high burden of cardiovascular disease (CVD), and the country has implemented a range of strategies aimed at controlling CVD. The study aims to conduct a content analysis of the policies implemented in the country and augment it with an analysis of official statistics over a 15-year period, from 2006 to 2020. The study also includes comparisons of incidence rates between urban and rural areas. A comprehensive search was conducted to identify policy documents that regulate the provision of primary, secondary, and tertiary prevention of cardiovascular diseases. Additionally, official data on the incidence of arterial hypertension, ischemic heart disease, acute myocardial infarction, and cerebrovascular disease were extracted from official statistics, disaggregated by urban and rural areas. Forecast modeling was utilized to project disease incidences up to 2030. The study reveals that Kazakhstan primarily focuses on tertiary prevention of cardiovascular diseases, with less attention given to secondary prevention, and primary prevention is virtually non-existent. In general, screening for arterial hypertension appears to be more successful than for ischemic heart disease. The incidence of arterial hypertension has increased threefold for urban residents and 1.7-fold for rural residents. In urban areas, residents saw a twofold increase in ischemic heart disease incidence, while it remained the same in rural areas. The findings of this study have practical implications for decision-makers, who can use the results to enhance the effectiveness of existing CVD prevention strategies.
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Affiliation(s)
- Natalya Glushkova
- Department of Epidemiology, Evidence-Based Medicine and Biostatistics, Kazakhstan's Medical University "Kazakhstan School of Public Health", Almaty, 050060, Kazakhstan
| | - Botagoz Turdaliyeva
- Kazakh Scientific Center of Dermatology and Infectious Diseases, Almaty, 050002, Kazakhstan
| | - Maksut Kulzhanov
- Department of Management in Healthcare and Pharmacy, Kazakhstan's Medical University "Kazakhstan School of Public Health", Almaty, 050060, Kazakhstan
| | - Indira K Karibayeva
- Department of Science and Consulting, Kazakhstan's Medical University "Kazakhstan School of Public Health", Almaty, 050060, Kazakhstan
| | - Maksut Kamaliev
- Department of Health Management, Kazakhstan's Medical University "Kazakhstan School of Public Health", Almaty, 050060, Kazakhstan
| | - Dariga Smailova
- Research Department, Asfendiyarov Kazakh National Medical University, Almaty, 050040, Kazakhstan
| | - Ayaulym Zhamakurova
- Department of Postgraduate Education, Kazakhstan's Medical University "Kazakhstan School of Public Health", Almaty, 050060, Kazakhstan
| | - Zhanar Namazbayeva
- Department of Postgraduate Education, Kazakhstan's Medical University "Kazakhstan School of Public Health", Almaty, 050060, Kazakhstan
| | - Gulmira Mukasheva
- Department of Postgraduate Education, Kazakhstan's Medical University "Kazakhstan School of Public Health", Almaty, 050060, Kazakhstan
| | - Asylzhan Kuanyshkalieva
- Department of Postgraduate Education, Kazakhstan's Medical University "Kazakhstan School of Public Health", Almaty, 050060, Kazakhstan
| | - Nurzhamal Otyzbayeva
- Department of Postgraduate Education, Kazakhstan's Medical University "Kazakhstan School of Public Health", Almaty, 050060, Kazakhstan
| | - Yuliya Semenova
- School of Medicine, Nazarbayev University, Astana, 010000, Kazakhstan
| | - Bagym Jobalayeva
- Department of Public Health, JSC "Semey Medical University", Semey, 071400, Kazakhstan.
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12
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Beavers CJ, Jurgens CY. Best Practice: Using Pharmacist- and Nurse-Led Optimization in Heart Failure to Achieve Guideline-directed Medical Therapy Goals. J Card Fail 2023; 29:1014-1016. [PMID: 37236501 DOI: 10.1016/j.cardfail.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Craig J Beavers
- University of Kentucky College of Pharmacy, Lexington, Kentucky.
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