Virtual Care Team Guided Management of Patients With Heart Failure During Hospitalization

Area of Science:

• Cardiology
• Health Services Research
• Digital Health

Background:

• Optimizing guideline-directed medical therapy (GDMT) for heart failure is crucial but challenging.
• Scalable and safe methods for GDMT optimization are needed, particularly for hospitalized patients.

Purpose of the Study:

• To assess the safety and effectiveness of a virtual care team strategy for GDMT optimization in hospitalized patients with heart failure with reduced ejection fraction (HFrEF).

Main Methods:

• A multicenter implementation trial compared a virtual care team strategy with usual care in 252 hospital encounters for patients with left ventricular ejection fraction ≤40%.
• The virtual care team provided daily GDMT optimization suggestions from a physician-pharmacist team.
• The primary outcome was in-hospital change in GDMT optimization score; safety outcomes were adjudicated independently.

Main Results:

• The virtual care team strategy significantly improved GDMT optimization scores compared to usual care (adjusted difference: +1.2; P < 0.001).
• New GDMT initiations and net intensifications were higher in the virtual care team group (absolute difference: +21% and +20%, respectively).
• Adverse events were similar between groups, with no significant differences in acute kidney injury, bradycardia, hypotension, hyperkalemia, or length of stay.

Conclusions:

• A virtual care team guided strategy is safe and effective for optimizing GDMT in hospitalized patients with HFrEF.
• This approach represents a centralized and scalable method for improving GDMT across multiple healthcare facilities.