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

Abstract

Implementation of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) remains incomplete. Non-cardiovascular hospitalization may present opportunities for GDMT optimization. We assessed the efficacy and durability of a virtual, multidisciplinary 'GDMT Team' on medical therapy prescription for HFrEF.

Heart failure drug titration, discontinuation, mortality and heart failure hospitalization risk: a multinational observational study (US, UK and Sweden)

“…use of potassium binders for preventing hyperkalaemia leading to discontinuation of GDMT). [54][55][56][57]…”

July 2021 at a glance: focus on blood volume distribution, haemodynamics and adherence to therapy

“…Bhatt et al 20 showed the usefulness of a pharmacist-physician GDMT team, compared to no team, to optimize treatment during a non-CV hospitalization of patients with HFrEF.…”

Optimizing evidence‐based heart failure medication: every contact counts

“…The study concluded that a structured remote patient management system reduced the percentage of days lost due to unplanned cardiovascular hospital admissions and all-cause mortality. 3 The innovative prospective, pre-post pilot interventional study by Bhatt et al, 4 represented by the acronym IMPLEMENT-HF, recruited 118 hospitalized patients to either usual care (n = 29) or a guideline-directed medical therapy (GDMT) Team intervention (n = 89), according to the month the patient was admitted. Criteria for exclusion were de novo HFrEF, recent acute coronary syndrome or stroke, recent cardiac surgery, systolic blood pressure <90 mmHg within the past 24 h, or coronavirus 2.…”

“…The study by Bhatt et al, 4 aimed to address the inequality of treatment provision to HF patients managed on a general medical ward, following a non-cardiovascular admission. This was accomplished through a shared care model, with development and implementation of a pharmaceutical guideline-based protocol, provision of education to non-HF specialists, coordination of care and delineation of roles between physician, GDMT Team and cardiology team for future follow-up.…”

“…Results indicated significant reduction in all-cause mortality between the intervention and control group (5% vs. 17.5%, P = 0.01), in addition to less days lost to hospitalization, dialysis, or death (13 vs. 30 days, P = 0.02), with a trend (P = 0.06) towards a reduction in hospitalizations as a result of the intervention. Similar to the IMPLEMENT-HF study by Bhatt et al, 4 medication changes were communicated to the primary cardiologist responsible for reviewing the patient after hospital discharge; however, a key step was absent, that being communication with the patient's GP. In doing so ensures a 'seamless' transition no matter where the patient begins or continues their healthcare journey.…”