A virtual care team guided strategy significantly improved in-hospital GDMT optimization scores compared to usual care among patients with HFrEF (adjusted difference +1.2; 95% CI 0.7-1.8; P<0.001).
RCT (n=252)
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Does a virtual care team guided strategy improve in-hospital GDMT optimization scores in hospitalized patients with HFrEF?
A virtual care team providing daily GDMT optimization suggestions significantly improved heart failure medication prescribing during hospitalization without increasing adverse events.
Mean Difference: 1.2 (95% CI 0.7–1.8)
valor p: p=< 0.001
BACKGROUND Scalable and safe approaches for heart failure guideline-directed medical therapy (GDMT) optimization are needed. OBJECTIVES The authors assessed the safety and effectiveness of a virtual care team guided strategy on GDMT optimization in hospitalized patients with heart failure with reduced ejection fraction (HFrEF). METHODS In a multicenter implementation trial, we allocated 252 hospital encounters in patients with left ventricular ejection fraction ≤40% to a virtual care team guided strategy (107 encounters among 83 patients) or usual care (145 encounters among 115 patients) across 3 centers in an integrated health system. In the virtual care team group, clinicians received up to 1 daily GDMT optimization suggestion from a physician-pharmacist team. The primary effectiveness outcome was in-hospital change in GDMT optimization score (+2 initiations, +1 dose up-titrations, −1 dose down-titrations, −2 discontinuations summed across classes). In-hospital safety outcomes were adjudicated by an independent clinical events committee. RESULTS Among 252 encounters, the mean age was 69 ± 14 years, 85 (34%) were women, 35 (14%) were Black, and 43 (17%) were Hispanic. The virtual care team strategy significantly improved GDMT optimization scores vs usual care (adjusted difference: +1.2; 95% CI: 0.7-1.8; P < 0.001). New initiations (44% vs 23%; absolute difference: +21%; P = 0.001) and net intensifications (44% vs 24%; absolute difference: +20%; P = 0.002) during hospitalization were higher in the virtual care team group, translating to a number needed to intervene of 5 encounters. Overall, 23 (21%) in the virtual care team group and 40 (28%) in usual care experienced 1 or more adverse events (P = 0.30). Acute kidney injury, bradycardia, hypotension, hyperkalemia, and hospital length of stay were similar between groups. CONCLUSIONS Among patients hospitalized with HFrEF, a virtual care team guided strategy for GDMT optimization was safe and improved GDMT across multiple hospitals in an integrated health system. Virtual teams represent a centralized and scalable approach to optimize GDMT.
“To see that a virtual care team could help improve guideline-concordant care across three diverse system hospitals and do so in a manner that was both safe and did not prolong hospitalization was a very encouraging finding.”
Bhatt et al. (Mon,) conducted a rct in Heart failure with reduced ejection fraction (HFrEF) (n=252). Virtual care team guided strategy vs. Usual care was evaluated on In-hospital change in GDMT optimization score (adjusted difference +1.2, 95% CI 0.7-1.8, p=< 0.001). A virtual care team guided strategy significantly improved in-hospital GDMT optimization scores compared to usual care among patients with HFrEF (adjusted difference +1.2; 95% CI 0.7-1.8; P<0.001).
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