Virtual optimization of guideline‐directed medical therapy in hospitalized patients with heart failure with reduced ejection fraction: the IMPLEMENT‐HF pilot study

摘要: AIMS Implementation of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) remains incomplete. Non-cardiovascular hospitalization may present opportunities GDMT optimization. We assessed the efficacy and durability a virtual, multidisciplinary 'GDMT Team' on prescription HFrEF. METHODS AND RESULTS Consecutive hospitalizations in patients HFrEF (ejection ≤40%) were prospectively identified from 3 February to 1 March 2020 (usual care group) 2 28 August (intervention group). Patients critical illness, de novo failure, systolic blood pressure <90 mmHg preceeding 24 hs prior enrollment excluded. In intervention group, pharmacist-physician Team provided optimization suggestions treating teams based an evidence-based algorithm. The primary outcome was score, sum positive (+1 new initiations or up-titrations) negative therapeutic changes (-1 discontinuations down-titrations) at hospital discharge. Serious in-hospital safety events assessed. Among 278 consecutive encounters HFrEF, 118 met eligibility criteria; 29 (25%) received usual 89 (75%) intervention. encounters, there no during hospitalization. β-blocker (72% 88%; P = 0.01), angiotensin receptor-neprilysin inhibitor (6% 17%; P = 0.03), mineralocorticoid receptor antagonist (16% 29%; P = 0.05), triple (9% 26%; P < 0.01) prescriptions increased After adjustment clinically relevant covariates, associated increase score (+0.58; 95% confidence interval +0.09 +1.07; P = 0.02). There serious adverse events. CONCLUSIONS are potentially safe effective setting A virtual improved This implementation strategy warrants testing prospective randomized controlled trial.