Title: Impact of a Clinical Pharmacist Workflow Change on Heart Failure Readmissions
Authors: Sean Ramoso, Kathrina Gonzales Raymundo, Natalie Ortiz-Gratacos, Richard Lane, Nicholas Mastromarino, Tracey Dobbs
Contact: [email protected] Background: Heart failure (HF) is a complex clinical syndrome and a leading cause of morbidity and mortality in the United States.1,2 Hospital readmissions due to HF are associated with increased costs and continue to be a growing health and economic burden.2,3 The American Heart Association estimates that the total costs of HF will increase from $31 billion in 2012 to $70 billion in 2030.4 To reduce HF readmissions, studies have evaluated the implementation of HF-focused multidisciplinary teams and observed reductions in 30-day HF readmission rates. These initiatives focused on transitions of care interventions such as telephone consultations, clinic follow-ups, and comprehensive patient education. Pharmacists can play a key role in these multidisciplinary teams through optimization of pharmacological guideline-directed medical therapy (GDMT) as recommended by the 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) Guidelines for the Management of Heart Failure. Further studies examining the impact of pharmacy-led interventions on HF readmissions and patient outcomes will be beneficial to identify the pharmacist’s role on the multidisciplinary team.
Methods: A single-center, retrospective, chart review was conducted at AdventHealth Apopka between December 23, 2025 to March 30, 2026. A clinical pharmacist workflow change was implemented, where pharmacists completed HF-focused admission and discharge medication reconciliation reviews aimed at optimizing pharmacological GDMT per the 2022 AHA/ACC/HFSA Guidelines for the Management of Heart Failure. Patients were included if they were 18 years or older, had a diagnosis of HF, and had a HF-focused admission medication reconciliation completed by a pharmacist. Patients were excluded if they were pregnant, had a history of a heart transplant, had a scheduled heart transplant at the time of the index visit, had a diagnosis of dementia, or were discharged to hospice. The primary outcome of this study was the incidence of 30-day cardiovascular (CV)-related readmission rates, based on the index hospital discharge date. Secondary outcomes included 30-day all-cause readmission, inpatient length of stay (LOS), and the incidence of HF GDMT optimization defined as a dose titration, addition/resumption, or discontinuation of a GDMT drug class.
Results: At the time of data analysis, the HF-focused pharmacist intervention group consisted of 52 patients who had 30-day readmissions data available. A comparator group of 52 patients admitted during the same study period without a HF-focused pharmacist intervention was utilized. For the primary outcome of 30-day CV-related readmission, this occurred in 9/52 (17.3%) patients in the intervention group and 11/52 (21.2%) patients in the comparator group (p = 0.495). For the secondary outcome of 30-day all-cause readmission, this occurred in 17/52 (32.7%) of patients in the intervention group and 16/52 (30.8%) of patients in the comparator (p = 0.946). The mean length of stay in the intervention group was 4.64 +/- 3.79 days compared with 2.94+/- 4 days in the comparator group (p = 0.056). HF GFMT optimization occurred in 41/52 (77.4%) patients in the comparator group and 28/52 (52.8%) of patients in the comparator group (p = 0.013).
Conclusion: A HF-focused pharmacist workflow change was associated with a numerical, but not statistically significant, reduction in 30-day CV-related readmissions. This pharmacist workflow change was also associated with a significant increase in the incidence of HF GDMT. Key barriers to GDMT optimization included weekday-only coverage, challenges in reliably identifying eligible HF patients, competing staffing responsibilities, and variable acceptance of GDMT recommendations which were often deferred to outpatient follow-up. Next steps should focus on expanding pharmacist coverage to increase completion of HF-focused medication reconciliations, refining the HF patient identification report, implementing strategies to improve GDMT recommendation uptake, and evaluating outcomes over a longer timeframe with a larger sample.
References - Heidenreich, P. A., et al. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18). https://doi.org/10.1161/cir.0000000000001063
- Urbich, M., Globe, G., Pantiri, K. et al. A Systematic Review of Medical Costs Associated with Heart Failure in the USA (2014–2020). PharmacoEconomics 38, 1219–1236 (2020). https://doi.org/10.1007/s40273-020-00952-0
- Kwok, C. S., et al. (2021). Cost of inpatient heart failure care and 30-day readmissions in the United States. International Journal of Cardiology, 329, 115–122. https://doi.org/10.1016/j.ijcard.2020.12.020
- Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the Impact of Heart Failure in the United States: A Policy Statement From the American Heart Association. Circulation: Heart Failure. 2013;6(3):606-619. doi:https://doi.org/10.1161/hhf.0b013e318291329a
