IMPLEMENT-HF: Virtual Care Team Can Improve GDMT Optimization in HFrEF

Ankeet Bhatt, MD

Among a patient population hospitalized with heart failure with reduced ejection fraction (HFrEF), a virtual care team-guided strategy improved guideline-directed medical therapy (GDMT) use across a single, integrated health system.¹

Based on these findings, virtual care teams may represent a centralized, scalable approach to optimize GDMT in patients with heart failure.

The research was presented in a Featured Clinical Research session at the American College of Cardiology (ACC) 2023 Annual Scientific Sessions in New Orleans, Louisiana.

Although strong evidence supports the use of GDMT, its use in HFrEF has historically remained low. Study investigators cited the need for safe approaches for GDMT optimization. To do so, the team assessed the efficacy and safety of a Virtual Care Team guided strategy versus usual care to improve HFrEF GDMT during hospitalization in the IMPLEMENT-HF trial.

They prospectively identified hospitalized patients with HFrEF (left ventricular ejection fraction [LVEF] ≤40%) using an electronic health record (EHR)-based algorithm at 3 centers within an integrated health system between October 2021 and June 2022.

Participants were then allocated by birth month to usual care or virtual care team-guided intervention. In the virtual care team group, clinicians received up to 1 daily GDMT optimization suggestion from a physician-pharmacist team using an evidence-based algorithm. Suggestions included ß-blockers, ACEi/ARB/ARNI, mineralocorticoid receptor antagonists [MRA], & sodium-glucose cotransporter 2 inhibitors [SGLT2]).

No in-person visits took place and prescribing decisions were at the discretion of treating teams, according to investigators. The primary efficacy outcomes included change in a composite GDMT optimization score and proportion of patients with GDMT initiations from hospital admission to hospital discharge and 30 days following discharge. Additionally, in-hospital safety outcomes were adjudicated by an independent clinical events committee

Among 252 clinical encounters, the mean age was 69 years, 85 patients (34%) were women, 35 (14%) were Black, and 43 (17%) were Hispanic. According to the results, the virtual care team strategy significantly improved GDMT scores compared with usual care (adjusted difference, 1.2; 95% confidence interval [CI], 0.7 - 1.8; P <.001).

Moreover, new initiations (44% vs. 23%; P = .001) and intensification of ≥ GDMT (50% vs. 28%; P = .001) were higher in the virtual care team group, translating to number needed-to-intervene of 5 encounters. Safety data showed 23 (21%) of patients in the virtual care team group and 40 (28%) in the usual care group experienced 1 or more safety events (P = .30), with rates of acute kidney injury, bradycardia, hypotension, and hyperkalemia similar between groups.

To gain more insight into this analysis, HCPLive spoke with Ankeet Bhatt, MD, Research Scientist, Kaiser Permanente Northern California, who presented the data at ACC 2023 on behalf of the IMPLEMENT-HF Investigators.

Watch a video of that interview below.

References

1. Bhatt A.S., Varshney A. S., Moscone A., et. al Virtual Care Team-Guided Therapeutic Optimization During Hospitalization in Patients with Heart Failure: The IMPLEMENT-HF Study, Journal of the American College of Cardiology, 2023, ISSN 0735-1097 https://doi.org/10.1016/j.jacc.2023.02.029.

Bhatt has no relevant disclosures to report.