2026 Eastern States Conference

Author: Nhi Lo, PharmD; Jenna Pham, PharmD, BCPS; Sheshadri Hoque, PharmD; Clare Livingston, PharmD
Learning Objective: Audience members will be able to describe the impact of pharmacist-led interventions on the optimization of heart failure GDMT.
Self-Assessment Question: True or False; Pharmacist-led interventions can increase the use of heart failure GDMT in hospitalized patients
Background/Objective: Evaluate the impact of pharmacist-led optimization of heart failure GDMT on the proportion of patients on optimal therapy at discharge.
Methods: This prospective study includes adult patients admitted to Inova Alexandria Hospital between January and April 2026 with a diagnosis of heart failure. Patients are excluded if they are younger than 18 years old or admitted for elective procedures. Pharmacists prospectively reviewed patient’s medication regimens to identify opportunities for GDMT optimization, including therapy initiation, dose titration, and discontinuation of inappropriate therapy. Pharmacists also provided discharge counseling while on service. The primary endpoints are the proportion of patients on optimal GDMT agents at discharge. Secondary outcomes include 30-day hospital readmission rates, number and type of pharmacist interventions, and a sub-analysis of the type of GDMT agents prescribed at discharge. 
Results: The proportion of patients on optimized GDMT significantly increased from 37% in the pre-implementation period to 47% in the post-implementation period (p = 0.02). The rate of 30-day readmission for this implementation period was 10%, which is a 5% decrease from hospital baseline in the first quarter of 2025 (p = 0.23). Sub-analysis revealed that beta-blocker optimization significantly increased in the post-implementation period for HFrEF patients (50% vs 89%; p = 0.01) and SGLT2-i optimization significantly increased in the HFpEF/HFmrEF population (29% vs 41%; p < 0.01). Conclusion: Pharmacist interventions led to higher rates of GDMT optimization, particularly in patients with HFpEF/HFmrEF. However, there were concurrent multidisciplinary initiatives conducted at Inova Alexandria that also contributed to the overall increase in GDMT optimization.