Virtual Care Team Guided Management of Patients With Heart Failure During Hospitalization.
J Am Coll Cardiol
; 81(17): 1680-1693, 2023 05 02.
Article
de En
| MEDLINE
| ID: mdl-36889612
ABSTRACT
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.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Défaillance cardiaque
Type d'étude:
Clinical_trials
/
Guideline
Limites:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Langue:
En
Journal:
J Am Coll Cardiol
Année:
2023
Type de document:
Article
Pays d'affiliation:
États-Unis d'Amérique