Virtual optimization of guideline-directed medical therapy in hospitalized patients with heart failure with reduced ejection fraction : the IMPLEMENT-HF pilot study
© 2021 European Society of Cardiology..
AIMS: Implementation of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) remains incomplete. Non-cardiovascular hospitalization may present opportunities for GDMT optimization. We assessed the efficacy and durability of a virtual, multidisciplinary 'GDMT Team' on medical therapy prescription for HFrEF.
METHODS AND RESULTS: Consecutive hospitalizations in patients with HFrEF (ejection fraction ≤40%) were prospectively identified from 3 February to 1 March 2020 (usual care group) and 2 March to 28 August 2020 (intervention group). Patients with critical illness, de novo heart failure, and systolic blood pressure <90 mmHg in the preceeding 24 hs prior to enrollment were excluded. In the intervention group, a pharmacist-physician GDMT Team provided optimization suggestions to treating teams based on an evidence-based algorithm. The primary outcome was a GDMT optimization score, the sum of positive (+1 for new initiations or up-titrations) and negative therapeutic changes (-1 for discontinuations or down-titrations) at hospital discharge. Serious in-hospital safety events were assessed. Among 278 consecutive encounters with HFrEF, 118 met eligibility criteria; 29 (25%) received usual care and 89 (75%) received the GDMT Team intervention. Among usual care encounters, there were no changes in GDMT prescription during hospitalization. In the intervention group, β-blocker (72% to 88%; P = 0.01), angiotensin receptor-neprilysin inhibitor (6% to 17%; P = 0.03), mineralocorticoid receptor antagonist (16% to 29%; P = 0.05), and triple therapy (9% to 26%; P < 0.01) prescriptions increased during hospitalization. After adjustment for clinically relevant covariates, the GDMT Team was associated with an increase in GDMT optimization score (+0.58; 95% confidence interval +0.09 to +1.07; P = 0.02). There were no serious in-hospital adverse events.
CONCLUSIONS: Non-cardiovascular hospitalizations are a potentially safe and effective setting for GDMT optimization. A virtual GDMT Team was associated with improved heart failure therapeutic optimization. This implementation strategy warrants testing in a prospective randomized controlled trial.
| Errataetall: |
CommentIn: Eur J Heart Fail. 2021 Jul;23(7):1202-1204. - PMID 33932310 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:23 |
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| Enthalten in: |
European journal of heart failure - 23(2021), 7 vom: 07. Juli, Seite 1191-1201 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bhatt, Ankeet S [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 10.08.2021 Date Revised 02.06.2023 published: Print-Electronic CommentIn: Eur J Heart Fail. 2021 Jul;23(7):1202-1204. - PMID 33932310 Citation Status MEDLINE |
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| doi: |
10.1002/ejhf.2163 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM323245315 |
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| 100 | 1 | |a Bhatt, Ankeet S |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Virtual optimization of guideline-directed medical therapy in hospitalized patients with heart failure with reduced ejection fraction |b the IMPLEMENT-HF pilot study |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Completed 10.08.2021 | ||
| 500 | |a Date Revised 02.06.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Eur J Heart Fail. 2021 Jul;23(7):1202-1204. - PMID 33932310 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021 European Society of Cardiology. | ||
| 520 | |a AIMS: Implementation of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) remains incomplete. Non-cardiovascular hospitalization may present opportunities for GDMT optimization. We assessed the efficacy and durability of a virtual, multidisciplinary 'GDMT Team' on medical therapy prescription for HFrEF | ||
| 520 | |a METHODS AND RESULTS: Consecutive hospitalizations in patients with HFrEF (ejection fraction ≤40%) were prospectively identified from 3 February to 1 March 2020 (usual care group) and 2 March to 28 August 2020 (intervention group). Patients with critical illness, de novo heart failure, and systolic blood pressure <90 mmHg in the preceeding 24 hs prior to enrollment were excluded. In the intervention group, a pharmacist-physician GDMT Team provided optimization suggestions to treating teams based on an evidence-based algorithm. The primary outcome was a GDMT optimization score, the sum of positive (+1 for new initiations or up-titrations) and negative therapeutic changes (-1 for discontinuations or down-titrations) at hospital discharge. Serious in-hospital safety events were assessed. Among 278 consecutive encounters with HFrEF, 118 met eligibility criteria; 29 (25%) received usual care and 89 (75%) received the GDMT Team intervention. Among usual care encounters, there were no changes in GDMT prescription during hospitalization. In the intervention group, β-blocker (72% to 88%; P = 0.01), angiotensin receptor-neprilysin inhibitor (6% to 17%; P = 0.03), mineralocorticoid receptor antagonist (16% to 29%; P = 0.05), and triple therapy (9% to 26%; P < 0.01) prescriptions increased during hospitalization. After adjustment for clinically relevant covariates, the GDMT Team was associated with an increase in GDMT optimization score (+0.58; 95% confidence interval +0.09 to +1.07; P = 0.02). There were no serious in-hospital adverse events | ||
| 520 | |a CONCLUSIONS: Non-cardiovascular hospitalizations are a potentially safe and effective setting for GDMT optimization. A virtual GDMT Team was associated with improved heart failure therapeutic optimization. This implementation strategy warrants testing in a prospective randomized controlled trial | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a GDMT Team | |
| 650 | 4 | |a Guideline-directed medical therapy | |
| 650 | 4 | |a Heart failure | |
| 650 | 4 | |a Implementation science | |
| 650 | 7 | |a Mineralocorticoid Receptor Antagonists |2 NLM | |
| 700 | 1 | |a Varshney, Anubodh S |e verfasserin |4 aut | |
| 700 | 1 | |a Nekoui, Mahan |e verfasserin |4 aut | |
| 700 | 1 | |a Moscone, Alea |e verfasserin |4 aut | |
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| 700 | 1 | |a Jering, Karola S |e verfasserin |4 aut | |
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| 700 | 1 | |a Kelly, Julie |e verfasserin |4 aut | |
| 700 | 1 | |a Knowles, Danielle M |e verfasserin |4 aut | |
| 700 | 1 | |a Lupi, Kenneth |e verfasserin |4 aut | |
| 700 | 1 | |a Malloy, Rhynn |e verfasserin |4 aut | |
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| 700 | 1 | |a Ting, Clara |e verfasserin |4 aut | |
| 700 | 1 | |a McElrath, Erin E |e verfasserin |4 aut | |
| 700 | 1 | |a Amato, Mary G |e verfasserin |4 aut | |
| 700 | 1 | |a Alobaidly, Maryam |e verfasserin |4 aut | |
| 700 | 1 | |a Ulbricht, Catherine E |e verfasserin |4 aut | |
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