Guideline-Directed Medical Therapy in Patients After Implantation of Implantable Cardioverter Defibrillators to Improve Outcomes

<h2>Abstract</h2><h3>Background</h3> Despite well-established benefits, guideline directed medical therapy (GDMT) is often underutilized following cardiac implantable electronic device (CIED) implantation). We sought to determine the rate of GDMT and whether a specialized intervention could improve GDMT and heart failure (HF) outcomes in a CIED clinic. <h3>Methods</h3> This is a prospective quasi-experimental observational cohort study performed from July, 2020 to April, 2022. Patients were included if they had a CIED with left ventricular ejection fraction (LVEF) ≤35%. The intervention consisted of a 12-month program in a specialized heart function clinic and device optimization. Controls were those that were eligible but did not participate in the intervention. The outcome measures were improvement in GDMT, NTproBNP, NYHA class, LVEF, HF-related emergency department visits/hospitalizations. <h3>Results</h3> After screening 942 patients, 220 were identified to have an LVEF ≤35%, of which 58% were not on GDMT (intervention n=29; control n=99). In the intervention group, 54% of patients reached four classes of GDMT, compared to 2.1% of the control group (p<0.001). HF-related emergency department visits/hospitalization were significantly reduced in the intervention group (3.4% vs 14.1%, p=0.018). NT-proBNP was reduced by 25% and LVEF increased by 6.5% in the intervention group. No difference in mortality was noted. <h3>Conclusions</h3> This study demonstrates a specialized heart failure intervention to optimize GDMT in patients with CIEDs, was associated with an improved NTproBNP and fewer heart failure related emergency department visits/hospitalizations, highlighting an important addressable gap in management of CIED patients.