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

The University of Michigan integrated health care system implemented a team-based care model to optimize guideline-directed medical therapy (GDMT) for patients with advanced heart failure with reduced ejection fraction (HFrEF). This team-based care model comprises office visits, video visits, and telemanagement.

The purpose of this study was to evaluate whether the frequency of each component of this care model, office visits, video visits, and telemanagement enhances GDMT optimization.

The authors conducted a retrospective cohort study of adults with HFrEF managed from July 2021 to October 2024 (n = 1,331). For each encounter type, patients were categorized as low, medium, or high frequency (tertiles). The primary outcome was time to GDMT optimization (medication optimization score = 100%). Cox models were specified as: model A (all 3 encounter types), model B (model A + demographics and HF severity [Heart Failure Patient Severity Index]), and model C (model A + demographics and comorbidity [Charlson Comorbidity Index]). Weighted Cox analysis was also conducted.

In unweighted models, telemanagement demonstrated an association with GDMT optimization (model A: medium HR: 1.46 [95% CI: 1.14-1.87]; high HR: 1.97 [95% CI: 1.51-2.57]), consistent in models B and C. The frequency of office and video encounters were not significantly associated with GDMT optimization. In weighted model, telemanagement association strengthened (medium HR: 2.06 [95% CI: 1.51-2.80]; high HR: 2.73 [95% CI: 1.97-3.79]) and high frequency of office encounters was associated with GDMT optimization.

Increased telemanagement frequency was consistently associated with faster GDMT optimization in HFrEF. Telemanagement, in addition to office and video visits, may be an essential mode of clinical care that can be used to optimize GDMT more rapidly.