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In-Hospital Virtual Peer-to-Peer Consultation to Increase Guideline-Directed Medical Therapy for Heart Failure: A Pilot Randomized Trial.
Rao, Vishal N; Shah, Anand; McDermott, Jaime; Barnes, Stephanie G; Murray, Evan M; Kelsey, Michelle D; Greene, Stephen J; Fudim, Marat; DeVore, Adam D; Patel, Chetan B; Blazing, Michael A; O'Brien, Cara; Mentz, Robert J.
  • Rao VN; Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
  • Shah A; Department of Medicine, Duke University Medical Center, Durham, NC.
  • McDermott J; Division of Cardiology, Duke University Medical Center, Durham, NC.
  • Barnes SG; Division of Cardiology, Duke University Medical Center, Durham, NC.
  • Murray EM; Department of Medicine, Duke University Medical Center, Durham, NC.
  • Kelsey MD; Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
  • Greene SJ; Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
  • Fudim M; Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
  • DeVore AD; Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
  • Patel CB; Division of Cardiology, Duke University Medical Center, Durham, NC.
  • Blazing MA; Division of Cardiology, Duke University Medical Center, Durham, NC.
  • O'Brien C; Department of Medicine, Duke University Medical Center, Durham, NC.
  • Mentz RJ; Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
Circ Heart Fail ; 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2277780
ABSTRACT

Background:

Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) improves clinical outcomes and quality of life. Optimizing GDMT in the hospital is associated with greater long-term use in HFrEF. This study aimed to describe the efficacy of a multidisciplinary virtual HF intervention on GDMT optimization among patients with HFrEF admitted for any cause.

Methods:

In this pilot randomized, controlled study, consecutive patients with HFrEF admitted to non-cardiology medicine services for any cause were identified at a large academic tertiary care hospital between May to September 2021. Major exclusions were end-stage renal disease, hemodynamic instability, concurrent COVID-19 infection, and current enrollment in hospice care. Patients were randomized to a clinician-level virtual peer-to-peer consult intervention providing GDMT recommendations and information on medication costs vs. usual care. Primary endpoints included 1) proportion of patients with new GDMT initiation or use, and 2) changes to HF optimal medical therapy (OMT) scores which included target dosing (range 0-9).

Results:

Of 242 patients identified, 91 (38%) were eligible and randomized to intervention (N=52) or usual care (N=39). Baseline characteristics were similar between intervention and usual care (mean age 63 vs. 67 years, 23% vs. 26% female, 46% vs. 49% Black, mean EF 33% vs. 31%). GDMT use on admission was also similar. There were greater proportions of patients with GDMT initiation or continuation with the intervention compared with usual care. After adjusting for OMT score on admission, changes to OMT score at discharge were higher for the intervention group compared with usual care (+0.44 vs. -0.31, absolute difference +0.75, adjusted estimate 0.86 ± 0.42; p=0.041).

Conclusions:

Among eligible patients with HFrEF hospitalized for any cause on non-cardiology services, a multidisciplinary pilot virtual HF consultation increased new GDMT initiation and dose optimization at discharge.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Prognostic study / Randomized controlled trials Language: English Journal subject: Vascular Diseases / Cardiology Year: 2022 Document Type: Article Affiliation country: CIRCHEARTFAILURE.122.010158

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Prognostic study / Randomized controlled trials Language: English Journal subject: Vascular Diseases / Cardiology Year: 2022 Document Type: Article Affiliation country: CIRCHEARTFAILURE.122.010158