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Virtual Care Team-Guided Therapeutic Optimization During Hospitalization in Patients with Heart Failure: The IMPLEMENT-HF Study. Journal of the American College of Cardiology 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., Lupi, K., Matta, L. S., Pimentel, L. Y., Rhoten, M. N., Malloy, R., Ting, C., Chhor, R., Guerin, J. R., Schissel, S. L., Hoa, B., Lio, C. H., Milewski, K., Espinosa, M. E., Liu, Z., McHatton, R., Cunningham, J. W., Jering, K. S., Bertot, J. H., Kaur, G., Ahmad, A., Akash, M., Davoudi, F., Hinrichsen, M. Z., Rabin, D. L., Gordan, P. L., Roberts, D. J., Urma, D., McElrath, E. E., Hinchey, E. D., Choudhry, N. K., Nekoui, M., Solomon, S. D., Adler, D. S., Vaduganathan, M. 2023

Abstract

Scalable and safe approaches for heart failure GDMT optimization are needed.We assessed the safety and effectiveness of a virtual care team-guided strategy on GDMT use in hospitalized patients with HFrEF.In a multicenter implementation trial, we allocated 252 hospital encounters in patients with LVEF=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. Primary effectiveness outcome was in-hospital change in GDMT optimization score (+2 initiations, +1 dose uptitrations, -1 dose downtitrations, -2 discontinuations summed across classes). In-hospital safety outcomes were adjudicated by an independent clinical events committee.Among 252 encounters, 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 scores vs. usual care (adjusted difference +1.2;95% CI:0.7-1.8;P<0.001). New initiations (44% vs.23%;P=0.001) and intensifications of =1 GDMT (50% vs.28%;P=0.001) were higher in the virtual care team group, translating to a number-needed-to-intervene of 5 encounters. Overall, 23(21%) in virtual care team group and 40(28%) in usual care experienced 1 or more safety events(P=0.30). AKI, bradycardia, hypotension, and hyperkalemia were similar between groups.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, scalable approach to optimize GDMT.

View details for DOI 10.1016/j.jacc.2023.02.029

View details for PubMedID 36889612