IMPLEMENT-HF: Virtual Care Team-Guided Strategy Optimizes GDMT For Hospitalized HF Patients

A virtual care team-guided strategy for guideline-directed medical therapy (GDMT) optimization was found to be safe and improve therapy among patients hospitalized with heart failure with reduced ejection fraction (HFrEF), according to a multicenter implementation trial presented at ACC.23/WCC and simultaneously published in JACC.

Ankeet S. Bhatt, MD, MBA, MSc, et al., allocated patients with a left ventricular EF ≤40% to a virtual care team-guided strategy (107 encounters among 83 patients) or usual care (145 encounters among 115 patients). The patients were from three centers in an integrated health care delivery system. Their mean age was 69 years, 34% were women, 14% Black and 17% Hispanic.

Clinicians in the virtual care team group received up to once daily recommendations for optimizing GDMT from a physician-pharmacist team. The primary goal was to improve early treatment of four major drugs classes (beta-blockers; ACE inhibitors/ARB/ARNI; mineralocorticoid receptor antagonists; SGLT2i). Effectiveness was measured by the in-hospital change in the optimization score (+2 initiations, +1 dose uptitrations, –1 downtitrations, –2 discontinuations summed across classes), and in-hospital safety outcomes were analyzed by an independent clinical events committee.

Results showed that GDMT optimization scores improved with the virtual care team strategy vs. usual care (adjusted difference +1.2; 95% CI, 0.7-1.8; p<0.001). In these groups respectively, there was a higher rate of new initiation of GDMT (44% vs. 23%; p=0.001) and intensifications of ≥one GDMT 50% vs. 28%; p=0.001). This translated to a number-needed-to-intervene of five encounters to optimize GDMT during hospitalization.

In terms of safety outcomes, there was no significant excess in adjudicated serious adverse events (21% vs. 28%) in the intervention and control groups, respectively, had one or more safety events (p=0.30), with similar rates of acute kidney injury, bradycardia, hypotension and hyperkalemia.

The study authors emphasized the benefits of the tested platform being fully virtual. They write, “This strategy represents a potential highly effective, scalable intervention that can lead to accelerated implementation of guideline concordant HFrEF care.”

Clinical Topics: Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Acute Heart Failure, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: ACC Annual Scientific Session, ACC23, Stroke Volume, Heart Failure, Angiography

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