Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 81(17), 1680–1693. https://doi.org/10.1016/j.jacc.2023.02.029 Dr. Ankeet Bhatt et al.
Points
- The study assessed the safety and effectiveness of a virtual care team-guided strategy on guideline-directed medical therapy (GDMT) optimization in hospitalized patients with heart failure with reduced ejection fraction (HFrEF).
- The virtual care team-guided strategy involved clinicians receiving up to 1 daily GDMT optimization suggestion from a physician-pharmacist team.
- The study found that the virtual care team strategy significantly improved GDMT optimization scores, new GDMT initiations, and net GDMT intensifications during hospitalization compared to usual care.
- The virtual care team strategy was also safe, with adverse events occurring similarly between the virtual and usual care teams.
- The study highlights the potential of virtual teams as a centralized and scalable approach to optimize GDMT in patients with HFrEF, which could lead to improved outcomes for this patient population.
Summary
Heart failure guideline-directed medical therapy (GDMT) optimization is crucial to improve outcomes for patients with heart failure with reduced ejection fraction (HFrEF). However, scalable and safe approaches for GDMT optimization are needed. In a multicenter implementation trial, the authors aimed to assess the safety and effectiveness of a virtual care team-guided strategy on GDMT optimization in hospitalized patients with HFrEF.
The trial included 252 hospital encounters in patients with left ventricular ejection fraction ≤40%, with a mean age of 69 ± 14 years, of which 85 (34%) were women, 35 (14%) were Black, and 43 (17%) were Hispanic. The virtual care team-guided strategy involved clinicians receiving up to 1 daily GDMT optimization suggestion from a physician-pharmacist team. The primary effectiveness outcome was the in-hospital change in GDMT optimization score, which was significantly higher in the virtual care team group than in usual care (adjusted difference: +1.2; 95% CI: 0.7-1.8; P < 0.001).
The study also found that new GDMT initiations during hospitalization were significantly higher in the virtual care team group compared to usual care (44% vs. 23%; absolute difference: +21%; P = 0.001), as were net GDMT intensifications (44% vs. 24%; absolute difference: +20%; P = 0.002). This translates to a number needed to intervene of 5 encounters. The virtual care team strategy was also safe, with adverse events occurring in 21% of patients in the virtual care team group and 28% in the usual care group (P = 0.30). Acute kidney injury, bradycardia, hypotension, hyperkalemia, and hospital length of stay were similar between the groups.
Overall, the study provides evidence that a virtual care team-guided strategy for GDMT optimization in hospitalized patients with HFrEF is safe and effective. The strategy resulted in significantly higher GDMT optimization scores, new GDMT initiations, and net intensifications during hospitalization. The study highlights the potential of virtual teams as a scalable and centralized approach to optimize GDMT in patients with HFrEF, which could lead to improved outcomes for this patient population.
Link to the article: https://onlinelibrary.wiley.com/doi/full/10.1002/clc.24018
References Bhatt, A. S., Varshney, A. S., Moscone, A., Claggett, B. L., Miao, Z. M., Chatur, S., Lopes, M. S., Ostrominski, J. W., Pabon, M. A., Unlu, O., Wang, X., Bernier, T. D., Buckley, L. F., Cook, B., Eaton, R., Fiene, J., Kanaan, D., Kelly, J., Knowles, D. M., … Vaduganathan, M. (2023). Virtual care team guided management of patients with heart failure during hospitalization. Journal of the American College of Cardiology, 81(17), 1680–1693. https://doi.org/10.1016/j.jacc.2023.02.029
