Novel Initiative Increasing GDMT Use among Patients with Heart Failure with Reduced Ejection Fraction

Guideline-directed medical therapy utilization in patients with HFrEF remains low despite benefits in morbidity and mortality. The authors describe a unique Quality Improvement initiative designed to increase ARNI and MRA utilization in outpatients with HFrEF in a large cardiology practice, whereby eligible patients were identified in a standardized review process and medication utilization rates were linked to group quality metrics. Eligible HFrEF patients were defined as having an LVEF ≤ 40% and NYHA Class II-IV level of symptoms. Those with an LVEF > 40%, no documented LVEF, or with NYHA Class I symptoms were excluded. ARNI utilization was defined as any dose of sacubitril/valsartan prescribed, and MRA utilization was defined as any dose of either spironolactone or eplerenone prescribed. Group quality metric targets were set at > 25% ARNI prescription and > 60% MRA prescription in eligible patients. Following project implementation, ARNI utilization rose from 31% to 67% and MRA increased from 28% to 66%. Establishing clear quality metrics and formulating a proactive evaluation process was associated with a significant increase in prescription rates.