Pharmacist-Led Heart Failure GDMT Clinic
In conversation with Josh Rajkumar, PharmD, BCPS and Vijay Rao, MD, PhD, FACC
Pharmacist’s Role in Heart Failure Clinics
Vijay Rao, MD, PhD, FACC, the outgoing governor of the Indiana Chapter of the American College of Cardiology, and Josh Rajkumar, PharmD, BCPS, a pharmacist at Franciscan Health, discussed the role of a pharmacist in guideline-directed medical therapy clinics. They shared their experience in building a heart failure clinic and the positive impact it has had on patient care. Dr. Rajkumar highlighted the collaborative efforts and the benefits for both the organization and the patients.
Heart Failure Service Workflow and Impact
Josh discussed the workflow of his service for heart failure, which involves scheduling appointments within two weeks, meeting with patients over a period of three or four visits over six to eight weeks, and optimizing GGMT. He also shared data on the impact of their work, including a 51% improvement in patients on quadruple therapy, a significant increase in the use of high-cost medications, and a 90% improvement in patients achieving maximally tolerated GDMT. The data showed a significant reduction in hospitalizations and readmissions, with a 9% all-cause death or heart failure readmission within 90 days and a 5% readmission within 90 days.
Pharmacist’s Role in Medication Access
Josh discussed the role of a pharmacist in ensuring patients have sustainable access to medications, particularly high-cost ones. He shared data showing a high success rate in getting medications approved for patients, often at an affordable price. Vijay asked about the challenges of justifying the cost of a pharmacist’s salary and how they overcame these hurdles. Josh explained that they approach this from an RVU perspective, allowing providers to focus on more complex patients and bill at a higher level. He also mentioned the reduction in hospitalizations as a cost-saving initiative. Vijay asked about the success rate in getting expensive drugs affordable for patients, and Josh shared strategies such as patient assistance programs, manufacturer coupons, and persistence in prior authorizations.
Heart Failure Patient Transition Workflow
Vijay and Josh discussed the workflow for patients coming out of the hospital after a heart failure admission. They emphasized the importance of ensuring patients are in a stable state before transitioning to the next stage. Josh shared his experience with titration, noting that he can achieve maximally tolerated doses within 4 to 6 weeks, which is crucial within the first one to two months. He also discussed his approach to handling hypovolemic patients, including interfacing with clinicians and ordering labs. Vijay ended the conversation by expressing appreciation for Josh’s work and encouraging others to reach out for further information.
