Olivia Hanson: Where are health systems still falling short in optimizing GDMT for heart failure, atherosclerotic cardiovascular disease, and cardiometabolic disease?
Kristen Campbell, PharmD, BCPS, CPP, FACC: I think what Glenn said is the simplest way to put it—actually getting the medications to patients. And if they’re not candidates, making sure that’s documented so mistakes don’t happen down the road. The biggest issue is implementation, which connects directly to your point.
Craig Beavers, PharmD, FCCP, BCPS-AQ Cardiology: I agree. Cardio-kidney-metabolic disease is “new but not new”—the concept isn’t new, but the way we’re breaking down silos and approaching it is. There are still places that haven’t tapped into a pharmacy strategy or don’t know how to build the infrastructure for it. There’s also more opportunity to engage our community-based peers, especially in transitions of care. Glenn, anything you’d add?
Glenn Herrington, PharmD, FACC, FHFSA, BCCP, CPP, HFCert: Yes. Getting the word out is key. Providers know the 4 pillars of heart failure GDMT, but I often see patients who are only on 1 or 2 components, or they’re on all 4 but not optimized. The barriers are often financial or related to time. As pharmacists, we have more time—we can follow up every 2 to 4 weeks. Telehealth and remote patient management give us unique ways to close those gaps.
Key Takeaways for Pharmacists
- Implementation—not awareness—is the biggest guideline-directed medication therapy gap. Pharmacists can close these gaps through medication access support, repeated follow-up, and documentation of contraindications.
- Pharmacist-led clinics and collaborative practice agreements consistently improve outcomes.
- Translating guidelines into practice requires proactive electronic medical record use. Pulling in laboratory tests, identifying missing parameters, standardizing workflows, and setting clear care plans at the first visit help ensure guideline recommendations become patient-specific actions.
- Emerging therapies demand new workflow and access competencies. Pharmacists must be prepared to navigate medical vs pharmacy benefits, prior authorizations, and implementation challenges as personalized therapies expand.
Hanson: And what pharmacist-led strategies have been most effective in improving adherence to evidence-based pathways?
Beavers: Several. Any time pharmacists help develop a process or protocol—especially within a CPA [collaborative practice agreement]—we see success. Hypertension management is a good example. Pharmacists also play a major role in EHR [electronic health record] strategies, setting up systems to identify patients, follow up, and support population-based health work. Kristen?
Campbell: Transitions of care are huge. Pharmacists are involved at all points of that process, and there’s still a lot of opportunity. Patient education is also critical. In my antiarrhythmic clinic, patients on long-term therapy often need reinforcement about drug interactions or safety considerations. Education keeps them safe. Glenn?
Herrington: I agree. Dedicated pharmacist clinics allow us to establish a care plan with the patient, involve them in decision-making, and set expectations. Routine touchpoints—whether in person or via telemedicine—help ensure monitoring, avoid interactions, and maintain adherence.
Hanson: How do pharmacists help translate national cardiovascular guidelines into practical, patient-specific decisions at the point of care?
Campbell: We remind providers of the medications patients need, educate patients about why they’re important, and reinforce information after the initial overload that comes with a diagnosis. Whether inpatient or outpatient, pharmacists help patients understand what to expect and why guidelines matter.
Herrington: I’d add that leveraging the EMR [electronic medical record] is huge. In my clinic, new patient visits are an hour long, and smart phrases pull in relevant labs and parameters. We identify gaps at baseline, address what’s missing, and create a plan. Pharmacists have more flexibility in our practice model to close those gaps.
Beavers: And pharmacists don’t just know the recommendations—we know how to help patients access therapies, streamline regimens, and navigate barriers. We also understand the gray areas where patients don’t neatly fit guidelines, which is where pharmacist expertise adds real value.
Hanson: Which emerging therapeutic classes should pharmacists pay attention to over the next 12 to 18 months?
Beavers: We could each pick something different. Kristen?
Campbell: I’d love to say new antiarrhythmics are on the way, but those are rare. In electrophysiology, a major focus is new delivery systems—like intranasal class Ic agents. That’s what we’re watching.
Beavers: In hypertension, aldosterone synthase inhibitors may be approved this year based on data such as what we’ve seen with baxdrostat. We also have injectable siRNA [small interfering RNA] therapy in development with large CVOTs [cardiovascular outcome trials] under way, potentially offering every-6-month options for treatment resistance. And, of course, continued expansion of GLP-1s [glucagon-like peptide-1s].
Herrington: Exactly. We can’t take our eye off medications we already have—GLP-1s, SGLT2 inhibitors, nonsteroidal MRAs [mineralocorticoid receptor agonists]. They increasingly have multiple indications, which helps streamline therapy. But many emerging therapies are personalized injectables. Navigating medical vs pharmacy benefits, prior authorization, and workflow differences is becoming a bigger part of ambulatory practice.
Beavers: And we’re seeing rapid expansion in areas that historically had few options—amyloidosis, hypertrophic cardiomyopathy. Plus developments in anticoagulation, like factor XI inhibitors.
Hanson: What role do pharmacists play in smoothing transitions between inpatient and outpatient settings for complex cardiovascular patients? Glenn, want to start?
Herrington: Sure. Discharge is the highest-risk moment. It starts on the inpatient side with good med rec [medication reconciliation], starting GDMT before discharge, identifying gaps, and coordinating early follow-up with the ambulatory team. On the outpatient side, for patients admitted for antiarrhythmic initiation, we do prehospital education, med rec, and ensure there are no issues that could delay care. Kristen?
Campbell: Practicing in both environments gives me a unique perspective. I’m thorough at discharge to ensure everything is clear. For EP [electrophysiology] patients, especially those on amiodarone loads, we standardize how they complete their load at home so they don’t accidentally restart a loading regimen. We’ve also created systems to identify high-risk patients and proactively refer them to our HF [heart failure] GDMT pharmacist with context on their gaps, so the outpatient pharmacist is ready to support them.
Beavers: And I’d add that meds-to-beds programs have been very successful in supporting these transitions.
