Implementing a telemedicine-led heart failure medication regimen optimization clinic in medically underserved heart failure populations.

Abstract

Background: Suboptimal guideline-directed medical therapy (GDMT) management for heart failure (HF) is a critical issue in rural communities. Most patients with HF in rural communities are treated in primary care settings. Multidisciplinary telemedicine-led HF medication optimization clinics were implemented to improve access to specialty care and address health disparities in HF care in rural Appalachian areas.

Objectives: The project aimed to evaluate the effect of a multidisciplinary telemedicine HF medication optimization clinic on the use of GDMT in cardiology and primary care services.

Methods: This pilot study was a multicenter prospective cohort study over a 6-month follow-up period. Patients aged > 18 years with HF with reduced ejection fraction or HF with mildly reduced ejection fraction were included. Telemedicine visits were conducted every 2 to 4 weeks. The primary outcome was the use of all 4 GDMT classes.

Results: The use of all 4 GDMT agents was numerically higher in HF cardiology service (n = 70) than the general cardiology cohort (n = 11) at baseline (46% vs. 9%), 1 month (55% vs. 18%), 3 months (58% vs. 18%), and 6 months (52% vs. 18%). The individual use of angiotensin receptor neprilysin inhibitor (ARNI), mineralocorticoid receptor antagonist (MRA), or sodium-glucose cotransporter 2 inhibitor (SGLT2I) was also numerically higher in HF cardiology service over 6 months. In the primary care service (n = 25), the use of all 4 GDMT agents was not significantly changed over 6 months. ARNI and beta-blocker use was numerically increased from the baseline to follow-up periods. MRA use was numerically decreased from baseline to follow-up periods. SGLT2I use was not significantly changed.

Conclusion: The multidisciplinary telemedicine approach was effective in the HF service group for GDMT optimization. However, further academic detailing for primary care and general cardiology services is needed, focusing on the initiation and persistence of MRA and SGLT2I and dose titration of GDMT agents.