Getting Heart Failure Patients the Meds They Really Need

The entrance to the Pat and Jim Cardiology Center at UConn Health on June 27, 2018. (Stan Godlewski for UConn Health)

Less than 25% of heart failure patients nationally are receiving the medications and targeted drug doses they need to improve their weakened heart muscle’s function, reduce their chronic debilitating symptoms, and to keep them out of the hospital.

But the experts at UConn Health’s Pat and Jim Calhoun Cardiology Center are working toward changing this statistic and getting more heart failure patients on the appropriate heart failure medication regimens recommended by the joint national guidelines of the American College of Cardiology (ACC) and the American Heart Association (AHA).

UConn Health is now home to a pilot Guideline Directed Medical Therapy Clinic (GDMT Clinic) aimed at finding ways to boost and maintain the health of patients with new or chronic heart failure with low heart muscle pumping strength known as reduced left ventricular ejection fraction (LVEF).

“The goal of our Guideline Directed Medical Therapy Clinic is to get heart failure patients on track with the standard of care medical therapy quickly, and to stay on track,” says Dr. Sara Tabtabai, principal investigator of the pilot study at UConn Health. She is the Director of the Health Failure Program at the Calhoun Cardiology Center and assistant professor of medicine at UConn School of Medicine. “In addition, we aim to reduce heart failure readmissions in our patients.”

In the GDMT clinic, heart failure experts work closely with each heart failure patient to assess their heart health, rapidly prescribe them the standard of care heart failure medication regimen, and closely monitor their health and heart failure symptoms to ensure they have the best chance of benefitting from medical therapy. In addition, the experts hope to reduce heart failure patient hospitalizations, improve their outcomes, and enhance their daily quality of life.

“Heart failure is a weakness of the heart muscle and is a chronic illness putting patients at a higher risk of recurrent hospitalization and increased chance of mortality,” says Mary Beth Barry, APRN of UConn Health’s Heart Failure Program. “But optimal, standard of care medications known as guideline directed medical therapy can indeed reduce these risks if actually prescribed by doctors and adhered to by heart failure patients.”

The national guidelines recommend that heart failure patients with reduced ejection fraction are on a certain set of medications. These include: Angiotensin Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, Angiotensin Receptor Blockers/Neprilysin Inhibitors, BetaBlockers, Aldosterone Antagonists, Nitrates and directed vascular vasodilators (Hydralazine).

Patients experience heart failure when the heart can’t pump enough blood to meet the body’s needs. This weakened heart muscle condition can lead to chronic, debilitating symptoms of:

  • Severe shortness of breath.
  • Chronic cough, especially when lying down.
  • Fluid retention
  • Fatigue.
  • Limited mobility and exercise capacity.
  • Leg, ankle, foot and abdominal swelling.

“Despite the longstanding, wide availability of heart failure medications, the majority of patients with heart failure are not on the appropriate medical therapy they need,” says Kerry Cipriani, APRN of UConn Health. “Our Clinic hopes to change this trend. We are working to improve the heart muscle function of our heart failure patients, improving the way they feel daily, and reducing their rate of hospitalization and risk of dying from the disease.”

The national rate of heart failure hospital readmissions within 30 days is 25%. UConn Health’s research team hopes its pilot GDMT Clinic can help its heart failure patients experience a reduced hospital readmission rate overall of at least 20 percent or even less.

“The nurses in the Calhoun Cardiology Center review the list of hospitalized patients daily in an effort to ensure that their discharge from the hospital goes smoothly. Their medications are reviewed as well as the heart failure zones,” says Laura Kearney, RN, BSN, Heart Failure Nurse Coordinator. “We communicate with the visiting nurses and make sure they have a follow-up in the GDMT clinic.”

The researchers believe the information, findings and progress of their pilot GDMT Clinic results will not only improve their heart failure patient medical therapy and overall outcomes, but also will help better guide the future care of heart failure patients by other providers locally and nationally.

In addition to Dr. Tabtabai and heart failure specialized APRNs Barry and Cipriani, the pilot study’s co-investigators also include: Dr. John Glenn Tiu, Dr. Jason Ryan, and Min Jung Kim, Ph.D. at UConn Health.

The GDMT Clinic is seeking study participants who are 18 years of age or older and have new and chronic systolic heart failure with LVEF that is less than 40%.

Patients or physicians interested in learning more about the pilot Guideline Directed Medical Therapy Clinic can contact the Pat and Jim Calhoun Cardiology Center at (860) 679-3343.