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The Association Between Office, Video, and Telemanagement Encounters and GDMT Optimization in Advanced HFrEF.

Mohamed S Ali1, Kaitlyn M Greer1, Sabah Ganai1

  • 1Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA.

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Summary

Increased telemanagement frequency significantly speeds up guideline-directed medical therapy (GDMT) optimization for heart failure with reduced ejection fraction (HFrEF). This approach enhances GDMT optimization for HFrEF patients.

Keywords:
advanced heart failure practiceguideline-directed medical therapyheart failure with reduced ejection fractiontelehealthtelemanagementtelemedicine

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Area of Science:

  • Cardiology
  • Health Services Research
  • Digital Health

Background:

  • A team-based care model was implemented to optimize guideline-directed medical therapy (GDMT) for advanced heart failure with reduced ejection fraction (HFrEF).
  • The model integrated office visits, video visits, and telemanagement for comprehensive patient care.

Purpose of the Study:

  • To evaluate the impact of varying frequencies of office visits, video visits, and telemanagement on GDMT optimization in HFrEF patients.
  • To determine which components of the integrated care model most effectively enhance GDMT optimization.

Main Methods:

  • A retrospective cohort study included 1,331 adult patients with HFrEF from July 2021 to October 2024.
  • Patients were categorized into low, medium, or high frequency tertiles for each encounter type (office, video, telemanagement).
  • Cox models, including weighted analysis, assessed the time to GDMT optimization (medication optimization score = 100%).

Main Results:

  • Higher frequency of telemanagement was consistently associated with faster GDMT optimization in unweighted and weighted Cox models.
  • In weighted analysis, increased telemanagement frequency showed a strengthened association with GDMT optimization (medium HR: 2.06; high HR: 2.73).
  • High frequency of office encounters was also associated with GDMT optimization in the weighted model, while video visits showed no significant association.

Conclusions:

  • Increased telemanagement frequency is strongly associated with accelerated GDMT optimization in HFrEF.
  • Telemanagement, alongside traditional office and video visits, represents a crucial component for rapid GDMT optimization.
  • The findings suggest telemanagement is a vital tool for improving care for HFrEF patients.