Pharmacist- and Nurse-Led Medical Optimization in Heart Failure: A Systematic Review and Meta-Analysis
Abstract
Background: Traditional approaches to guideline-directed medical therapy (GDMT) management often lead to delayed initiation and titration of therapies in heart failure. This study sought to characterize alternative models of care involving non-physician provider-led GDMT interventions and their associations with therapy utilization and clinical outcomes. Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCT) and observational studies comparing non-physician provider-led GDMT initiation and/or uptitration interventions versus usual physician care (PROSPERO ID: CRD42022334661). We queried PubMed, Embase, the Cochrane Library, and the World Health Organization International Clinical Trial Registry Platform for peer-reviewed studies from database inception to July 31, 2022. In the meta-analysis, we used RCT data only and leveraged random-effects models to estimate pooled outcomes. Primary outcomes were GDMT initiation and titration to target doses by therapeutic class. Secondary outcomes included all-cause mortality and HF hospitalizations. Results: 33 studies were reviewed, of which 17 (52%) were randomized controlled trials with median follow-up of 6 months. 14 (82%) trials evaluated nurse interventions, while the remainder assessed pharmacist interventions. The primary analysis pooled data from 16 RCTs, which enrolled 5,268 patients. Pooled risk ratios (RR) for RASI and BB initiation were 2.09 (95% CI 1.05-4.16; I2=68%) and 1.91 (95%…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 5,268 participants or records.
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