Improving Utilization of Guideline-Directed Medical Therapy for Heart Failure

We developed a structured nurse practitioner and pharmacist–led program for guideline-directed medical therapy optimization, with the aim of increasing the use of novel therapies, including angiotensin receptor–neprilysin inhibitors and sodium glucose cotransporter 2 inhibitors. This quality improvement project included 198 patients with heart failure with reduced and midrange ejection fraction. Most patients who completed the program received the maximum tolerated dose of angiotensin receptor–neprilysin inhibitors (86.8%), beta-blockers (100%), mineralocorticoid receptor antagonists (79.6%), and sodium glucose cotransporter 2 inhibitors (68.5%). The proportion of patients achieving the maximum and target doses of guideline-directed medical therapy demonstrated improvement in left ventricular ejection fraction, New York Heart Association class, and N-terminal pro–B-type natriuretic peptide with no negative impact on safety.