Background: Heart failure (HF) is a complex medical condition associated with high hospital readmission rates, placing a significant burden on hospital resources. Attempts to improve outcomes and quality of life for these patients have led to significant advances in patient care in terms of medical therapies and risk reduction measures. However, the increased complexity of treating HF associated with these advances has also made healthcare navigation and patient compliance more difficult. For patients hospitalized with heart failure, goal-directed medical therapy (GDMT) leads to improved patient outcomes and reduces rehospitalizations, thus reducing the cost of care. Inadequate GDMT translates to a 29% excess mortality risk over just a 2-year period of follow-up. While patient compliance encompasses a large realm of social determinant factors, the consistent prescription of GDMT by physicians is the first step.

Methods: We analyzed prescription rates of patients hospitalized between 2/1/2024 – 5/1/2024 with HF with reduced ejection fraction (HFrEF). This included 54 patients who were pre-educational interventions and 80 patients who were post-educational interventions. The Quality Improvement (QI) project intervention included an in-person presentation as well as an email sent to all internal medicine residents with a succinct one-pager and full PowerPoint presentation. It additionally involved the creation of an HF order set hard-coded into the hospital’s electronic medical record. This included but was not limited to a list of GDMT medications (angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) or angiotensin receptor/neprilysin inhibitor (ARNI), beta blockers (BB), mineralocorticoid receptor antagonist (MRA)), daily weights, ins and outs, a therapeutic diet, elevation of the bed, cardiac rehabilitation referral, and other useful lab work. Of note, sodium-glucose cotransporter 2 (SGLT-2) inhibitors were excluded as part of GDMT as they are not on the formulary at our institution.

Results: After the QI project intervention, beta blocker prescription rates rose from 77.8% to 92.5%. Angiotensin receptor blocker prescription rates changed from 81.5% to 76.3%. Mineralocorticoid receptor antagonist prescription rates rose from 46.3% to 57.5%.

Conclusion: This project demonstrated that educational sessions as well as HF order sets can improve GDMT prescription rates. However, our results also indicate the need for continued improvements. Repeat educational sessions as well as improvement of order sets with the incorporation of heart failure coordinators and care management consults are starting points to continue optimizing GDMT rates.