Article Impact Level: HIGH Data Quality: STRONG Summary of Nature Medicine, 1–7. https://doi.org/10.1038/s41591-024-03238-6 Dr. Jelle P. Man et al.
Points
- The ADMINISTER trial studied 150 patients with heart failure. It reduced ejection fraction (HFrEF), comparing standard care to a digital consults (DC) strategy that included remote consultations, patient education, and guideline-based recommendations.
- The DC strategy involved digital data sharing, text-based patient education, and guideline recommendations integrated into the electronic health record for clinicians before remote consultations.
- The trial’s primary measure, the guideline-directed medical therapy (GDMT) score, improved significantly more in the DC group (1.19) compared to the usual care group (0.08) over 12 weeks (p<0.001).
- The study demonstrated the effectiveness of the DC strategy in optimizing GDMT adherence for HFrEF patients, suggesting improved management of heart failure through remote digital interventions.
- The trial’s results indicate that integrating digital consults into clinical workflows can enhance adherence to evidence-based therapies, offering a scalable solution for addressing care variations and resource limitations in heart failure management.
Summary
In the ADMINISTER trial, an investigator-initiated multicenter study, 150 patients with heart failure and reduced ejection fraction (HFrEF) were randomized to receive either standard care or a digital consults (DC) strategy. This novel DC approach included digital data sharing from patients to clinicians, patient education through text-based e-learning, and the provision of guideline recommendations directly to treating clinicians. All patient information was processed into a digital summary accessible in the electronic health record before each consultation, with all interactions conducted remotely.
The trial measured the change in guideline-directed medical therapy (GDMT) scores over 12 weeks. Results demonstrated a significant improvement in the GDMT score in the DC group compared to the usual care group, with median changes of 1.19 in the DC group versus 0.08 in the usual care group (p<0.001). This outcome highlights the effectiveness of the DC strategy in optimizing GDMT among patients with HFrEF, marking a significant advancement in the management of heart failure.
The findings of the ADMINISTER trial suggest that remote digital interventions can effectively enhance GDMT adherence, potentially leading to improved patient outcomes in heart failure management. By integrating comprehensive patient data and guideline-based recommendations into the clinical workflow, digital consults may offer a scalable and efficient solution to underutilizing evidence-based therapies in heart failure, addressing resource limitations and variations in care delivery.
Link to the article: https://www.nature.com/articles/s41591-024-03238-6
References Man, J. P., Koole, M. A. C., Meregalli, P. G., Handoko, M. L., Stienen, S., de Lange, F. J., Winter, M. M., Schijven, M. P., Kok, W. E. M., Kuipers, D. I., van der Harst, P., Asselbergs, F. W., Zwinderman, A. H., Dijkgraaf, M. G. W., Chamuleau, S. A. J., & Schuuring, M. J. (2024). Digital consults in heart failure care: A randomized controlled trial. Nature Medicine, 1–7. https://doi.org/10.1038/s41591-024-03238-6
