The following is a summary of “Virtual Care Team Guided Management of Patients With Heart Failure During Hospitalization,” published in the May 2023 issue of Cardiology by Bhatt, et al.
There was a need for scalable and safe approaches to optimize guideline-directed medical therapy (GDMT) for heart failure. For a study, researchers sought to assess the safety and effectiveness of a virtual care team-guided strategy for GDMT optimization in hospitalized patients with heart failure with reduced ejection fraction (HFrEF).
In a multicenter implementation trial, 252 hospital encounters of patients with left ventricular ejection fraction ≤40% were allocated to either a virtual care team-guided strategy (107 encounters in 83 patients) or usual care (145 encounters in 115 patients) across three centers within an integrated health system. In the virtual care team group, clinicians received daily GDMT optimization suggestions from a physician-pharmacist team. The primary effectiveness outcome was the in-hospital change in GDMT optimization score, which considered the initiation, up-titration, down-titration, and discontinuation of medications (+2 initiations, +1 dose up-titrations, −1 dose down-titrations, −2 discontinuations summed across classes). An independent clinical events committee assessed safety outcomes.
Among the 252 encounters, the mean age was 69 ± 14 years, with 85 (34%) women, 35 (14%) Black individuals, and 43 (17%) Hispanic individuals. The virtual care team strategy significantly improved GDMT optimization scores compared to usual care (adjusted difference: +1.2; 95% CI: 0.7-1.8; P < 0.001). The virtual care team group had higher rates of new GDMT initiations (44% vs. 23%; absolute difference: +21%; P = 0.001) and net intensifications (44% vs. 24%; absolute difference: +20%; P = 0.002) during hospitalization, with a number needed to intervene of 5 encounters. Adverse events occurred in 23 (21%) patients in the virtual care team group and 40 (28%) patients in the usual care group (P = 0.30). The incidence of acute kidney injury, bradycardia, hypotension, hyperkalemia, and hospital length of stay was similar between the two groups.
In patients hospitalized with HFrEF, a virtual care team-guided GDMT optimization strategy was safe and effective across multiple hospitals within an integrated health system. Virtual teams provided a centralized and scalable approach to optimize GDMT in heart failure patients.