Document Type
DNP Project
Publication Date
4-9-2025
Degree Name
Doctor of Nursing Practice
Faculty Advisor
Dr. Susan Penque, PhD, APRN, ANP-BC, NE-BC, NC-
Practice Mentor
Dawn Surprenant, DNP, APRN, FNP-BC
Abstract
Significance and Background: Heart failure with reduced ejection fraction (HFrEF) remains a major cause of hospital readmissions, increasing both healthcare utilization and patient morbidity. Guideline-Directed Medical Therapy (GDMT) has been proven to reduce mortality and hospitalizations; however, adherence to these evidence-based guidelines remains inconsistent (Yancy et al., 2022).
Purpose: This quality improvement project aimed to evaluate whether enhancing GDMT adherence in an outpatient heart failure clinic could reduce emergency room (ER) admissions among patients with HFrEF.
Methods: A structured intervention was implemented at a local healthcare system Cardiology Clinic, focusing on optimizing adherence to GDMT in 60 patients with HFrEF. The project incorporated provider education, standardized medication titration protocols, and systematic medication reconciliation. Baseline and post-intervention data were collected over a 6-month period, assessing ER admission rates and compliance with GDMT.
Outcome: The intervention led to a 5% reduction in ER admissions, though the limited timeframe restricted the ability to observe long-term trends. Significant improvements were observed in the prescription rates of the four core GDMT drug classes (ARNI/ACEi/ARB, beta-blockers, MRAs, and SGLT2 inhibitors), aligning with current heart failure guidelines (McDonagh et al., 2021). Key barriers identified included patient noncompliance, medication cost constraints, and provider hesitancy in titration.
Discussion: While the reduction in ER admissions was modest, the project successfully demonstrated the feasibility of integrating structured GDMT adherence strategies in an outpatient heart failure setting. Future efforts should focus on extending the evaluation period, addressing patient-specific adherence challenges, and reinforcing provider adherence to GDMT protocols. These findings underscore the importance of sustained quality improvement efforts in optimizing heart failure management and reducing preventable hospital visits.
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Recommended Citation
Campbell-William, L. (2025). Optimizing care for heart failure patients with reduced ejection fraction: A quality improvement project on guideline directed medical therapy adherence [Unpublished DNP project]. Sacred Heart University. https://digitalcommons.sacredheart.edu/dnp_projects/97
Comments
A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.