Drug Utilization Research - Analyzing HFrEF Drug Therapy
September 5, 2023
For Hua Ling, PharmD, research is a vital way to connect clinical trial data with what he sees in his
daily practice. That connection, according to Ling, is not always straightforward.
“Sometimes there is a gap between the clinical trial and what we do in our daily practice,”
In a clinical trial, researchers attempt to determine if new medical treatments, drugs
or devices are safe and effective. Participants are carefully selected and the trial
is conducted under controlled circumstances. Ling’s research is focused on understanding how the medications studied in a clinical trial actually
work in real-world settings and how they impact patient outcomes.
As part of a recent research project, Ling analyzed results from a clinical trial
involving a drug therapy for patients with HFrEF (heart failure with reduced ejection
fraction). The therapy—a quadruple therapy with ARNI, beta-blockers, MRA, and SGLT2i—has
been established as first-line therapy for patients with HFrEF in current heart failure
In the trial, the drug therapy was up-titrated over a two-week span from the initial
low dose to the target dose.
“The selection criteria of the trials evaluating rapid titration of quadruple therapy
potentially restricted the external validity of those trials,” Ling explained. “So
we conducted a drug utilization analysis to retrospectively review the medical records
of patients with HFrEF at our clinic and assess their eligibility for the clinical
Connecting clinical trial data with real-world clinical practice can present challenges.
Ling's research is focused on understanding how medications studied in clinical trials
impact real-world patient outcomes.
Teaching pharmacy students to think analytically and raise questions about the effectiveness
and safety of medications can lead to improvements in patient care.
When Ling compared the characteristics of his patients with those selected to participate
in the clinical trial, he discovered that a substantial portion of his patients would
have been ineligible for the rapid titration therapy. Because of this, it would not
be possible for his patients to reliably see the benefits observed in the clinical
By running comparisons using data from patients’ medical charts, he and his team tried
to point out the study limitations, which were not fully addressed by the trial results.
“What we suggest is that perhaps we can be a little bit more conservative,” he said.
“Maybe we need a month or even more time. From a safety perspective, do we need two
weeks for rapid titration or can we go longer?”
According to Ling, studies of this nature are important.
“In our daily practice, we do not pick our patients,” he explained. “Therefore what
you see in the clinical study, you might not see that same outcome in our patients.”
Once they receive a prescription, pharmacists check to see if it is safe for the patient.
At a hospital level, pharmacists look for trends that would inform better usage of
“From the pharmacy perspective, we always care about the drug usage,” Ling said. “That
is a focus of this profession.”
In his role as an associate professor of pharmacy practice at PCOM School of Pharmacy, Ling is teaching his students to think about ways to improve patient outcomes by
reviewing emerging drug therapies.
In his medical writing class, Ling instructs his students to find a topic of interest
and search for information about new drug therapies, changes in treatment guidelines
or findings about the disease itself. Students must summarize their findings and present
them in the format of a mini-review.
Ling said he expects students to tell him what the problem is, describe what they
have found and, based on what they have found, explain if current practices should
be changed. The question, Ling added, is “Are we going to do new things or do the
findings reinforce that what we are doing is correct?”
This exercise is very similar to what Ling does when he retrospectively reviews charts
from clinical studies and prepares case reports.
“We raise the questions,” he said when describing how he examines data and attempts
to determine if there is more to be learned.
“It's just exciting to find something that has not been reported before, and then
we share it with the scientific community,” Ling said. “By conducting drug utilization
analysis, we can improve the quality of patient care, enhance therapeutic outcomes,
prevent adverse drug reactions, and reduce inappropriate pharmaceutical expenditures,
reducing overall healthcare costs.”