News | ACC | March 06, 2023

Virtual Care Team-Guided Strategy Optimizes GDMT for Hospitalized HF Patients in IMPLEMENT-HF Trial, According to Multi-Center Study Presented at ACC 23

Results of the IMPLEMENT-HF Trial show that a virtual care team-guided strategy for guideline-directed medical therapy (GDMT) optimization was found to be safe and improve therapy among patients hospitalized with heart failure with reduced ejection fraction (HFrEF). Findings were presented during a Featured Clinical Research session on the final day of the American College of Cardiology Annual Scientific Session Together with the World Congress of Cardiology, being held March 4-6 in New Orleans, LA.

Virtual Care Team-Guided Strategy was found to optimize GDMT for hospitalized HF patients according to results of the multi-center IMPLEMENT-HF Trial presented at ACC 23/WCC during a March 6 Featured Clinical Research session.

Results of the IMPLEMENT-HF Trial show that a virtual care team-guided strategy for guideline-directed medical therapy (GDMT) optimization was found to be safe and improve therapy among patients hospitalized with heart failure with reduced ejection fraction (HFrEF). Findings were presented during a Featured Clinical Research session on the final day of the American College of Cardiology Annual Scientific Session Together with the World Congress of Cardiology, ACC23 WCC, being held March 4-6 in New Orleans, LA.


March 7, 2023 — A virtual care team-guided strategy for guideline-directed medical therapy (GDMT) optimization was found to be safe and improve therapy among patients hospitalized with heart failure with reduced ejection fraction (HFrEF), according to a multicenter implementation trial presented at ACC.23/WCC and simultaneously published in the Journal of the American College of CardiologyJACC.

Findings were presented on the final day of the American College of Cardiology's Annual Scientific Session Together with the World Congress of CardiologyACC.23/WCC, by Ankeet S. Bhatt, MD, MBA, MSc. Bhatt, who presented significant findings from “Safety and Efficacy of Virtual Care Team Guided Therapeutic Optimization During Hospitalization in Patients with HFrEF: the IMPLEMENT-HF Study.” Bhatt is currently a Critical Care Cardiologist and Research Scientist/Investigator with Kaiser Permanente Division of Research (Oakland, CA), previously at Massachusetts General/Brigham & Women’s Hospital (Boston, MA), which funded the study.

In the study, Bhatt et al assessed the safety and effectiveness of a virtual care team-guided strategy on GDMT use in hospitalized patients with HFrEF.

“The virtual care team strategy was safe with no increase in adverse events, and the beneficial effects did not come at the expense of increasing hospital length of stay. All in all, virtual care teams represent an effective, scalable and safe approach to have FREF therapeutic optimization. I'd love to thank our large team without which this would not have been possible. And I'm very happy to report that these findings are now simultaneously published in JACC,” said Bhatt in concluding his presentation of findings during the March 6 Featured Clinical Research Session III on March 6 at ACC23/WCC in New Orleans.

The researchers allocated patients with a left ventricular EF ≤40% to a virtual care team-guided strategy (107 encounters among 83 patients) or usual care (145 encounters among 115 patients). The patients were from three centers in an integrated health care delivery system. Their mean age was 69 years, 34% were women, 14% Black and 17% Hispanic.

Clinicians in the virtual care team group received up to once daily recommendations for optimizing GDMT from a physician-pharmacist team. The primary goal was to improve early treatment of four major drugs classes (beta-blockers; ACE inhibitors/ ARB/ ARNI; mineralocorticoid receptor antagonists; SGLT2i). Effectiveness was measured by the in-hospital change in the optimization score (+2 initiations, +1 dose uptitrations, –1 downtitrations, –2 discontinuations summed across classes), and in-hospital safety outcomes were analyzed by an independent clinical events committee.

Results showed that GDMT optimization scores improved with the virtual care team strategy vs. usual care (adjusted difference +1.2; 95% CI, 0.7-1.8; p<0.001). In these groups respectively, there was a higher rate of new initiation of GDMT (44% vs. 23%; p=0.001) and intensifications of ≥one GDMT 50% vs. 28%; p=0.001). This translated to a number-needed-to-intervene of five encounters to optimize GDMT during hospitalization.

In terms of safety outcomes, there was no significant excess in adjudicated serious adverse events (21% vs. 28%) in the intervention and control groups, respectively, had one or more safety events (p=0.30), with similar rates of acute kidney injury, bradycardia, hypotension and hyperkalemia.

The study authors emphasized the benefits of the tested platform being fully virtual. They write, “This strategy represents a potential highly effective, scalable intervention that can lead to accelerated implementation of guideline concordant HFrEF care.”

In summarizing the findings, Bhatt reviewed the results: Among 252 encounters, mean age was 69±14 years, 85(34%) were women, 35(14%) were Black, and 43(17%) were Hispanic. The virtual care team strategy significantly improved GDMT scores vs. usual care (adjusted difference +1.2;95% CI:0.7-1.8;P<0.001). New initiations (44% vs.23%;P=0.001) and intensifications of ≥1 GDMT (50% vs.28%;P=0.001) were higher in the virtual care team group, translating to a number-needed-to-intervene of 5 encounters. Overall, 23(21%) in virtual care team group and 40(28%) in usual care experienced 1 or more safety events(P=0.30). AKI, bradycardia, hypotension, and hyperkalemia were similar between groups.

Among patients hospitalized with HFrEF, a virtual care team-guided strategy for GDMT optimization was safe and improved GDMT across multiple hospitals in an integrated health system. Virtual teams represent a centralized, scalable approach to optimize GDMT.

For more information: www.acc.org

https://www.jacc.org/

Find more ACC23 content here 


Related Content

News | Cardiovascular Education

May 31, 2024 — In the United States there are over 8 million active athletes. Given the rapid expansion of sports ...

Home May 31, 2024
Home
News | Cardiovascular Education

April 25, 2024 —Heart-Valve-Surgery.com, a leading patient advocacy group for heart valve disease, with support from ...

Home April 25, 2024
Home
News | Cardiovascular Education

March 21, 2024 — The UCLA Department of Medicine has announced that Priscilla Hsue, MD will be joining as the chief of ...

Home March 21, 2024
Home
Feature | Cardiovascular Education | Christine Book

February 1, 2024 — As cardiologists, heart disease patients and the organizations that serve them across the country ...

Home February 01, 2024
Home
News | Cardiovascular Education

January 15, 2024 — A public-private partnership Think Tank, scheduled for Feb. 29-March 1, will be presented by the ...

Home January 15, 2024
Home
News | Cardiovascular Education

December 4, 2023 — The Minneapolis Heart Institute Foundation (MHIF), an internationally renowned cardiovascular ...

Home December 04, 2023
Home
News | Cardiovascular Education

October 5, 2023 — The 2023 American College of Cardiology (ACC) Quality Summit kicks off on October 11-13 in Orlando ...

Home October 05, 2023
Home
News | Cardiovascular Education

DAIC’s award-winning editorial team delivers industry trends and technology information to the professionals who make ...

Home August 16, 2023
Home
Feature | Cardiovascular Education | Christine Book

May 4, 2023 — A new book on a broad collection of cases, led by a team of investigators from the Smidt Heart Institute ...

Home May 04, 2023
Home
News | Cardiovascular Education

April 10, 2023 — Viatris Inc., a global healthcare company, and the American College of Cardiology (ACC) today released ...

Home April 10, 2023
Home
Subscribe Now