Related Experiment Video
Updated: Aug 23, 2025
04:24
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
11.7K
In-Hospital Virtual Peer-to-Peer Consultation to Increase Guideline-Directed Medical Therapy for Heart Failure: A
Vishal N Rao1,2, Anand Shah3, Jaime McDermott1
1Division of Cardiology (V.N.R., J.M., S.G.B., M.D.K., S.J.G., M.F., A.D.D., C.B.P., M.A.B., R.J.M.), Duke University Medical Center, Durham, NC.
Circulation. Heart Failure
|October 31, 2022
Summary
A virtual heart failure (HF) intervention improved guideline-directed medical therapy (GDMT) for patients with reduced ejection fraction (HFrEF) during hospitalization. This approach increased medication initiation and optimization, enhancing patient care.
Area of Science:
- Cardiology
- Digital Health
- Health Services Research
Background:
- Guideline-directed medical therapy (GDMT) is crucial for improving outcomes in heart failure with reduced ejection fraction (HFrEF).
- Optimizing GDMT during hospitalization is linked to better long-term adherence in HFrEF patients.
- A virtual, multidisciplinary approach may enhance GDMT delivery for hospitalized HFrEF patients.
Purpose of the Study:
- To evaluate the efficacy of a virtual, multidisciplinary heart failure (HF) intervention.
- To assess the impact of this intervention on GDMT optimization in hospitalized HFrEF patients.
- To determine if the intervention increases GDMT initiation and improves therapy scores.
Main Methods:
- Pilot randomized controlled trial involving HFrEF patients admitted to noncardiology services.
- Intervention group received virtual peer-to-peer consults with GDMT recommendations; control group received usual care.
- Primary endpoints: proportion of patients with new GDMT initiation/use and changes in HF optimal medical therapy scores.
Main Results:
- 91 eligible HFrEF patients were randomized (52 intervention, 39 usual care).
- The intervention group showed greater GDMT initiation or continuation.
- Adjusted optimal medical therapy scores at discharge were significantly higher in the intervention group (+0.86, P=0.041).
Conclusions:
- A multidisciplinary virtual HF consultation is effective in increasing GDMT initiation.
- The intervention significantly improved HF medication dose optimization at discharge.
- This pilot study demonstrates the value of virtual interventions in managing hospitalized HFrEF.
Related Concept Videos
01:22Heart Failure VI: Adjunct Therapies
25
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
25
01:30Heart Failure V: Medical Management
19
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
19
01:30Heart Failure VII: Nursing Interventions
131
The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
131
01:29Cardiomyopathy V: Interprofessional Care
27
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
27
01:28Acute Coronary Syndrome IV: Interprofessional Care
22
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
22
01:30Heart Failure IV: Classification and Diagnostic Evaluation
27
Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
27