Non-Physician-Led Models of Care for Heart Failure Medication Optimization: A Scoping Review.

Background: Non-physician-led models of care may improve utilization of heart failure (HF) medication therapy. Characterizing these models may help guide their implementation. Methods: We searched MEDLINE (National Library of Medicine), Embase (Elsevier), Cochrane Central Register of Controlled Trials (CENTRAL), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) for studies published between January 2005 and October 2024. We included studies evaluating non-physician-led models of HFmedication management conducted at least partially in the outpatient setting. Study quality was assessed using the Oxford Centre for Evidence-Based Medicine levels of evidence, ranging from level 1 (systematic review of randomized trials) to level 5 (mechanism-based reasoning or expert opinion). Results: From 5330 records, we included 39 reports describing 31 studies with a total of 16,921 participants. All 31 studies included patients with HF with reduced ejection fraction, and 17 also included those with an ejection fraction > 40%. The levels of evidence classification in these studies were 2 (n = 2), 3 (n = 11), and 4 (n = 18).The most frequently studied professional roles were pharmacist (n = 26 studies) and nurse practitioners or clinicians (n = 9). Medication management was conducted in-person (n = 19), remotely (n = 6), and through a hybrid approach (n = 6). Median appointment frequency and duration were every 2 weeks (range: every 1-4 weeks) and 30 minutes (range: 15-60 minutes). Although non-physician-led models of care were associated with increased HF medication use compared to baseline, evidence was mixed regarding how these non-physician-led models compare to usual care in terms of improving use of guideline-directed medical therapy. Conclusions: Non-physician-led models of care are associated with improved HF medication use compared to baseline; however, substantial heterogeneity is present in implementation strategies and the impact of these improvements, compared to usual care.