Impact of Pharmacist Telehealth Comanagement for Heart Failure

Abstract

Background

Heart failure with reduced ejection fraction (HFrEF) imposes high morbidity and mortality burdens. Outcomes improve significantly with guideline-directed medical therapy (GDMT), but patients infrequently achieve target regimens in practice.

Objectives

The purpose of this study was to determine the effectiveness of telehealth-delivered pharmacist comanagement for patients with HFrEF vs usual care to: 1) achieve goal GDMT therapy; and 2) reduce health care utilization.

Methods

This nonrandomized controlled study, spanning 2022 to 2023, analyzed a health care delivery improvement project at an integrated health care network. In-network Medicare recipients with a HFrEF diagnosis (based on chart review) were divided into those covered by the network’s risk-sharing agreement (intervention group) vs otherwise similar (comparison group) patients. A difference-in-difference analysis with inverse propensity weighting adjusted for observable risk factors. Intervention patients received medication reconciliation, new drug initiation, dose adjustments, and safety monitoring by program pharmacists via telehealth. Main outcome measures were hospitalizations and achievement of target GDMT therapy.

Results

There were 190 intervention and 277 comparison group patients. The relative risk of cardiac hospitalization in the intervention group (vs comparison group) was 0.26 (95% CI: 0.08-0.86; P = 0.026), with an adjusted absolute risk reduction of 14.2 hospitalizations per 100 patient-years. In the intervention group, the ORs for achieving 3+ and 4 GDMT classes (vs comparison) were 2.73 (95% CI: 1.91-3.87; P < 0.001) and 2.27 (95% CI: 1.29-4.01; P = 0.005), respectively. The adjusted absolute increase in patients on 3+ and 4 GDMT classes were 23% and 21%, respectively.

Conclusions

A dedicated pharmacist comanagement telehealth program for patients with HFrEF proved effective at improving GDMT use and reducing cardiac hospitalizations.