Impact of optimal medical therapy in heart failure certification for hospitalists on guideline-directed medical therapy utilization.

Abstract

Background: Significant gaps in guideline-directed medical therapy (GDMT) for heart failure (HF) stem from shortages of cardiologists and advanced HF providers, as well as a lack of optimal HF management knowledge among hospitalists. This study compared the impact of optimal medical therapy in HF (OMT-HF) certification on GDMT implementation and patient outcomes between an intervention group (IG) of hospitalists and a standard-of-care comparison group (SOC-CG).

Aim: To evaluate if OMT-HF has a difference in GDMT and patients in outcomes between IG and SOC-CG.

Methods: This study was implemented from November 2022 to May 2023. Hospitalized cardiology patients with HF and left ventricular ejection fraction ≤ 40% were randomized to IG or SOC-CG. Exclusion criteria included patients in cardiogenic shock, unable to consent, or at high risk. Follow-up was at 30 days post-discharge. Differences between groups were analyzed using Fisher's exact test for categorical variables and Wilcoxon rank-sum or unpaired t-test for continuous variables. Changes in Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores were evaluated using a paired t-test.

Results: IG patients had lower readmission rates [(9 (42.85%) vs 11 (17.46%), P = 0.03] and a decreased trend in mortality 30-day post discharge. IG patients also showed greater mean improvements in total (-27.03 ± 24.59 vs -5.85 ± 23.52, P < 0.001), physical (-13.8 ± 12.3 vs -2.71 ± 11.16, P < 0.001) and emotional (-4.76 ± 8.10 vs -1.42 ± 5.98) dimensions on the MLWHFQ compared to SOC-CG, however, change in emotional dimension did not reach statistical significance.

Conclusion: Hospitalist OMT-HF certification may lead to better 30-day outcomes in hospitalized HF patients including quality of life, mortality and readmission rates. Larger prospective studies are warranted to validate these findings.