RAPID HF: A pragmatic pilot of a STRONG HF–Informed Pharmacist-Led HFrEF Optimization Program in Singapore

Background

Early post discharge optimization of guideline-directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF) remains challenging in routine practice. While STRONG-HF supports early intensive follow-up and rapid GDMT optimization, short lead times are often not feasible in cardiology clinics.

RAPID-HF (Rapid Access Protocol for Intensifying Drugs in Heart Failure) was implemented within the Cardiology Pharmacist Clinic (CPC), creating rapid access slots that shortened post-discharge and inter-visit lead times to 2 weeks (vs 6–8 weeks). RAPID-HF is Khoo Teck Puat Hospital’s first local application of STRONG-HF-informed pharmacist-led ambulatory optimization model.

Methods

This pragmatic prospective observational pilot ran for 12 weeks (Aug–Oct 2025). Adults with HFrEF (LVEF <40%) were included; patients with renal failure or GDMT contraindications were excluded. 

Of 13 eligible patients, 10 managed through CPC were analysed. RAPID HF emphasised early review, pharmacist led GDMT titration, blood pressure and laboratory surveillance with active management of treatment related issues. Outcomes were attainment of target or patient specific maximally tolerated doses, number of GDMT classes optimised, and safety-events resolution.

Results

Ten patients (mean age 64.5 years) attended a mean 2.7 CPC visits. By program end, all were prescribed all four foundational GDMT classes. 

Target or maximally tolerated dose attainment was 40% for ACEi/ARB/ARNI, 80% for bisoprolol, 100% for empagliflozin, and 60% for spironolactone; 40% achieved optimisation of all four classes.Safety events occurred in five patients at first visit; all were resolved in the ambulatory setting.

Conclusion

RAPID-HF demonstrates the feasibility of STRONG-HF-informed, pharmacist-led ambulatory HFrEF optimisation clinics, supporting evaluation in larger cohorts.