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Health System-Level Performance in Prescribing Guideline-Directed Medical Therapy for Patients with HFrEF: Results from the CONNECT-HF Trial.
Health System-Level Performance in Prescribing Guideline-Directed Medical Therapy for Patients with HFrEF: Results from the CONNECT-HF Trial. Journal of cardiac failure Granger, B. B., Kaltenbach, L. A., Fonarow, G. C., Allen, L. A., Lanfear, D. E., Albert, N. M., Al-Khalidi, H. R., Butler, J., Cooper, L. B., DeWald, T., Felker, G. M., Heidenreich, P., Kottam, A., Lewis, E. F., Pina, I. L., Yancy, C. W., Granger, C. B., Hernandez, A. F., DeVore, A. D. 2022Abstract
BACKGROUND: Health system-level interventions to improve use of guideline-directed medical therapy (GDMT) often fail in the acute care setting. We sought to identify factors associated with high performance in adoption of GDMT among health systems in CONNECT-HF.METHODS AND RESULTS: Site-level composite quality scores were calculated at discharge and last follow-up. Site performance was defined as the average change in score from baseline to last follow-up and analyzed by performance tertile using a mixed-effects model with baseline performance as a fixed effect and site as a random effect. Among 150 randomized sites, mean 12-month improvement in GDMT was 1.8% (-26.4% to 60.0%). Achievement of =50% target dose for angiotensin-converting enzymes/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors and beta blockers at 12 months was modest, even at the highest performing sites (median 29.6% [23%, 41%] and 41.2% [29%, 50%]). Sites achieving higher GDMT scores had care teams that included social workers and pharmacists and patients able to afford medications and access medication lists in the electronic health record.CONCLUSIONS: Substantial gaps in site-level use of GDMT were found even among highest performing sites. Failure of hospital-level interventions to improve quality metrics suggests that a team-based approach to care and improved patient access to medications are needed for post-discharge success.
View details for DOI 10.1016/j.cardfail.2022.03.356
View details for PubMedID 35462033