Patients with heart failure (HF) within the Duke system now have access to a clinic devoted to guideline-directed medical therapy (GDMT) to educate patients, help with medication access, and ensure they’re receiving the most appropriate medications. As part of the Duke Heart Failure Access Clinic, advanced HF specialist Aferdita Spahillari, MD, MPH, co-directs the Heart Failure Medication Titration GDMT Clinic, along with Stephen Greene, MD, and cardiac pharmacists Oksana Kamneva, PharmD, BCCP, BCCCP, CPP, and Erika Nicolsen, PharmD, CPP.

Any patient with HF being seen at Duke can be referred to the GDMT clinic, whether that patient has reduced (HFrEF) or preserved ejection fraction (EF). Initiated in April 2023, the GDMT clinic has seen more than 600 patients, with over 80% graduating the clinic on an optimal medication regimen.

“We’ve seen improvements in EF for patients with HFrEF after three months on therapy,” says Kamneva. “Even for patients who have not graduated from the clinic, we see improvement in requiring less diuretic and healthier blood pressure levels.”

The GDMT clinic sits alongside the Duke Heart Failure Access Clinic, staffed by HF specialists Greene and Paul Rosenberg, MD, and advanced practice providers Todd McVeigh, PA, and Midge Bowers, DNP, with the primary goal to treat patients with worsening signs and symptoms outside the hospital to prevent the need for admission.

The clinic educates patients to ensure adherence with prescribed medications and takes away the burden of frequent titration and monitoring from providers. “The data is staggering on the low prescription rate of GDMT nationwide,” says Spahillari. The reasons for this include lack of provider or patient knowledge regarding its benefits and limited resources. “Even though patients may have had heart failure for many years, sometimes they still don’t understand how their medications work and the importance of taking them.”

The clinic also helps patients to access their medications, Spahillari says: “Anyone that has difficulty accessing medications due to cost or who can’t navigate assistance programs on their own, we have our pharmacy technician, Jocelyn McAdoo, to help with that.”

To determine the best medication doses, pharmacists collaborate with physicians as well as the patients themselves for a full evaluation. The pharmacists then oversee aggressive medication titration for a short period to help the patient with their goals, counter any adverse events, and order further labs. This monitoring continues to determine the patient’s maximally tolerated doses.

“It’s been quite amazing what our team has been able to do in such an incredibly short amount of time,” says Spahillari. “This is a one-of-a-kind program that has changed how we care for our patients at Duke. This makes Duke’s heart failure services unique.”

As part of Duke’s advanced HF care, the GDMT clinic is only available to patients in the Duke system. “For additional heart failure treatment options like this clinic,” says Spahillari, “we encourage you to refer patients to Duke cardiology.”