Impact of Pharmacist Telehealth Comanagement for Heart Failure

Figure 1. Patient CONSORT Diagram Selection of patients for the intervention and comparison groups including the numbers included and excluded for each specific exclusion criterion. CABG = coronary artery bypass graft; CKD = chronic kidney disease; CONSORT = CONsolidated Standards Of Reporting Trials; DCE = direct contracting entity; EF = ejection fraction; EHR = electronic health record; HFrEF = heart failure with reduced ejection fraction; LVAD = left ventricular assist device; SNF = skilled nursing facility.

Figure 2. Unadjusted GDMT Achievement Rates Unadjusted fractions of intervention and comparison group patients on 0, 1, 2, 3, and 4 GDMT drug classes, by month from 12 months before until 12 months after index date. ARNi = angiotensin receptor–neprilysin inhibitors; GDMT = guideline-directed medical therapy; SGLT2i = sodium-glucose cotransporter-2 inhibitors.

Figure 3. Inverse Propensity of Treatment-Weighted Guideline-Directed Medical Therapy Achievement Rates (A) 3+ GDMT drug classes; (B) 4 GDMT drug classes; (C) An ARNi; (D) an SGL T2i; and (E) both an ARNi and an SGL T2i. Results of the inverse propensity-weighted analysis, showing both the adjusted and unadjusted preindex and postindex period fractions of patients achieving treatment with 3+ and 4 GDMT drug classes, ARNi, and SGLT2i, for the intervention and comparison groups, including 95% CIs. Abbreviations as in Figure 2.

Figure 4. Inverse Propensity of Treatment-Weighted Health Care Utilization Rates Results of the inverse propensity-weighted analysis, showing both the adjusted and unadjusted preindex and postindex period rates of (A) all-cause hospitalization, (B) cardiac hospitalization, (C) all-cause ED visits, and (D) cardiac ED visits for the intervention and comparison groups, including 95% CIs. ED = emergency department.

Central Illustration. Heart Failure Management Process and Outcomes (A) Proportion of patients in each group on 3+ GDMT drug classes; (B) rate of cardiac hospitalizations in each group. Eligible patients with heart failure were identified by records review, enrolled, then initiated on guideline-directed medical therapy (GDMT) via telehealth, resulting in a rapid, dramatic increase in GDMT attainment and decrease in subsequent cardiac hospitalizations Abbreviations as in Figure 1, Figure 2.