Methods:

IMPLEMENT-HF (Implementation of Medical Therapy in Hospitalized Patients With Heart Failure With Reduced Ejection Fraction) was designed as a prospective multi-institutional study in an integrated health system to evaluate the effectiveness and safety of a virtual care team. Patients were identified via electronic health records (EHRs). Daily, weekday screening was conducted by a centralized study physician via chart review across all three institutions at Mass General Brigham integrated health system. Patients were identified by previous echocardiogram in the last 12 months, or with de novo presentation of HFrEF at time of documentation.

Exclusion criteria included patients admitted to the intensive care unit, inotropic or mechanical circulatory support use during admission, acute coronary syndrome, stroke or major cardiovascular surgery within 30 days, systolic blood pressure <90 mm Hg in the preceding 24 hours, severe uncorrected valvular disease or moderate or greater right ventricular dysfunction on the most recent echocardiogram, admission for coronavirus disease 2019, or physician discretion.

The virtual care team guided intervention consisted of a centralized physician and study staff and local pharmacist at each site. Primary treating teams caring for patients allocated to the intervention group received up to once daily recommendations for GDMT optimization using an evidence-based algorithm. Final care optimization suggestions were communicated by progress notes in the EHR. Text messages were sent to the primary care team with a summary of what was placed in the patients’ chart. The virtual teams never saw the patients or conducted physical exams.