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Health System-Level Performance in Prescribing Guideline-Directed Medical Therapy for Patients With Heart Failure
Bradi B Granger1, Lisa A Kaltenbach2, Gregg C Fonarow3
1Duke Clinical Research Institute, Durham, NC; Duke University School of Nursing, Durham, NC; Duke University School of Medicine, Durham, NC.
Journal of Cardiac Failure
|April 24, 2022
Summary
Improving guideline-directed medical therapy (GDMT) adoption in acute care is challenging. High-performing sites involved social workers and pharmacists, and ensured patients could afford medications and access records.
Area of Science:
- Cardiology
- Health Services Research
- Pharmacotherapy
Background:
- Health system interventions for guideline-directed medical therapy (GDMT) often fall short in acute care settings.
- Identifying factors for successful GDMT adoption within health systems is crucial.
Purpose of the Study:
- To identify factors associated with high performance in GDMT adoption among health systems participating in the CONNECT-HF study.
Main Methods:
- Site-level composite quality scores were calculated at discharge and follow-up.
- Performance was analyzed using a mixed-effects model based on tertiles of performance change.
- 150 sites were randomized, with 12-month GDMT improvement analyzed.
Main Results:
- The mean 12-month improvement in GDMT was modest (1.8%).
- Achievement of target medication doses was limited, even at top-performing sites (median 29.6%-41.2%).
- High GDMT scores correlated with care teams including social workers and pharmacists, and patient medication affordability and EHR access.
Conclusions:
- Significant gaps in site-level GDMT use persist, even in high-performing institutions.
- Hospital-level interventions alone are insufficient for improving quality metrics.
- A team-based care approach and enhanced patient access to medications are essential for post-discharge success.
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