Effectiveness of Virtual Care Team Guided Management of Hospitalized Patients with HFrEF by Ethnicity.

IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
John H Bertot, Anubodh S Varshney, Alea Moscone, Brian L Claggett, Zi Michael Miao, Muhammad Akash, Maria Pabon, Jonathan W Cunningham, Tracy Makuvire, Scott D Solomon, Dale S Adler, Muthiah Vaduganathan, Ankeet S Bhatt
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引用次数: 0

Abstract

Background: The Implementation of Medical Therapy in Hospitalized Patients with Heart Failure with Reduced Ejection Fraction (IMPLEMENT-HF) study demonstrated that a virtual team-based care strategy was safe and improved prescription of guideline-directed medical therapy (GDMT) in hospitalized patients with heart failure and reduced ejection fraction (HFrEF). We evaluated differences in efficacy and safety outcomes by ethnicity in IMPLEMENT-HF.

Methods: IMPLEMENT-HF evaluated a provider-facing virtual team-based care strategy versus usual care in hospitalized patients with HFrEF from October 2021 to June 2022. The primary outcome was change in a GDMT optimization score from hospital admission to discharge, with positive changes reflecting net optimization. In this post-hoc analysis, we assessed heterogeneity in treatment effects by ethnicity (Hispanic vs. non-Hispanic). Outcomes included prespecified primary and secondary effectiveness outcomes and adjudicated safety events.

Results: Of 808 screened patient admissions, 252 (31%) from 198 unique patients met inclusion criteria. Hispanic patients (n = 43) were more likely to have diabetes and end-stage kidney disease than non-Hispanics; 70% spoke Spanish as a primary language. GDMT optimization score was lower among Hispanic versus non-Hispanic patients (-0.44; 95% CI -1.88 to 0.99 vs. +1.62, 95% CI +1.02 to +2.21; P value of interaction by ethnicity = .002). Allocation to the virtual care team intervention versus usual care increased the proportion of patients experiencing >1 new initiation or dose up-titration among non-Hispanic patients but did not among Hispanic patients (absolute difference non-Hispanic vs. Hispanic: +31% vs. -19%; P value of interaction = .003). Similar trends were seen among individual HF therapy and for the proportion of patients with optimization score >0 (absolute difference non-Hispanic vs. Hispanic: +29% vs. -20%; P value of interaction = .005). Safety outcomes were similar among Hispanic and non-Hispanic patients.

Conclusion: A provider-facing, virtual care team-guided strategy for HFrEF GDMT optimization was less effective in Hispanic patients. Efforts to identify and reduce bias and equity assessments in implementation studies are needed.

虚拟护理团队指导下不同种族HFrEF住院患者管理的有效性。
背景:implemente - hf证明了一种虚拟的基于团队的护理策略是安全的,并且改善了住院心力衰竭和射血分数降低(HFrEF)患者的指导药物治疗(GDMT)处方。我们评估了不同种族在IMPLEMENT-HF治疗中疗效和安全性结果的差异。方法:从2021年10月至2022年6月,对HFrEF住院患者采用面向提供者的虚拟团队护理策略与常规护理进行评估。主要结局是入院至出院期间指导药物治疗(GDMT)优化评分的变化,阳性变化反映净优化。在这个事后分析中,我们评估了不同种族(西班牙裔与非西班牙裔)治疗效果的异质性。结果包括预先指定的主要和次要有效性结果和确定的安全性事件。结果:在808名被筛选的入院患者中,来自198名独特患者的252名(31%)符合纳入标准。西班牙裔患者(n=43)比非西班牙裔患者更容易患糖尿病和终末期肾病;70%的人以西班牙语为主要语言。西班牙裔患者的GDMT优化评分低于非西班牙裔患者(-0.44,95% CI: -1.88至0.99 vs. +1.62, 95% CI: +1.02至+2.21;种族间相互作用的p值= 0.002)。与常规护理相比,虚拟护理团队干预增加了非西班牙裔患者中经历bbbb1新起始或剂量增加的患者比例,但在西班牙裔患者中没有(非西班牙裔与西班牙裔的绝对差异:+31%对-19%;相互作用的p值 = 0.003)。在单个心衰治疗和优化评分为b>的患者比例中也出现了类似的趋势(非西班牙裔与西班牙裔的绝对差异:+29%对-20%;相互作用的p值 = 0.005)。西班牙裔和非西班牙裔患者的安全性结果相似。结论:面向提供者、虚拟护理团队指导的HFrEF GDMT优化策略在西班牙裔患者中效果较差。需要努力识别和减少导致这种观察到的差异的偏见,并进行更多样化的实施研究。
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来源期刊
Journal of Cardiac Failure
Journal of Cardiac Failure 医学-心血管系统
CiteScore
7.80
自引率
8.30%
发文量
653
审稿时长
21 days
期刊介绍: Journal of Cardiac Failure publishes original, peer-reviewed communications of scientific excellence and review articles on clinical research, basic human studies, animal studies, and bench research with potential clinical applications to heart failure - pathogenesis, etiology, epidemiology, pathophysiological mechanisms, assessment, prevention, and treatment.
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