Limitations
This study had several limitations. It was retrospective, and its sample size was too small for conclusions regarding morbidity and mortality. As the population was predominantly African American males, results may not be applicable to other races and females. Furthermore, not evaluating HF causes at baseline could have confounded results, as disease progression, response to medications, and prognosis can vary, depending on etiology. Moreover, as patients are referred from the HFDMP to the PMTC, there may have been a bias in patient selection for the PMTC group. Patients in the PMTC group may have been more clinically stable yet had a larger knowledge deficit, an adherence issue, or a need for difficult, frequent titrations. Patients also may have been less likely to be seen during the first 30 days after discharge. In addition, it could have been beneficial to match patients on NYHA class of HF at baseline to ensure HF severity was balanced between groups. Last, the adherence analysis may not be accurate, as it relied on refill history, which may not reflect how medications were taken at home.
It would be beneficial to expand this initial study with a larger sample. Presumed HF causes and medication adherence should be captured at baseline. Additional endpoints, including quality of life and patient cognition, could enhance results. Furthermore, comparing the HFDMP with the general cardiology clinic may reveal other benefits of a focused HFDMP and its PMTC. Last, evaluating patients who are recently discharged from HF admission yet not enrolled in the HFDMP may provide more information regarding the utility of both the HFDMP and the PMTC.
Conclusion
For the PMTC group in this study, achievement of target BB doses and achievement in composite clinical GDMT were significant, but achievement of target ACEI/ARB doses were not.