Virtual Care Team Guided Management of Patients With Heart Failure During Hospitalization.

Autor:	Bhatt AS; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA; Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, California, USA., Varshney AS; Division of Cardiovascular Medicine, Stanford University, Palo Alto, California, USA., Moscone A; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Claggett BL; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA., Miao ZM; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA., Chatur S; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA., Lopes MS; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA., Ostrominski JW; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA., Pabon MA; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA., Unlu O; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA., Wang X; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA., Bernier TD; Rush University Medical Center, Chicago, Illinois, USA., Buckley LF; Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts, USA., Cook B; Mass General Brigham Center for Drug Policy, Boston, Massachusetts, USA., Eaton R; Department of Pharmacy, Ohio State University Wexner Medical Center, Columbus, Ohio, USA., Fiene J; Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts, USA., Kanaan D; Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts, USA., Kelly J; Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA., Knowles DM; Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts, USA., Lupi K; Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts, USA., Matta LS; Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts, USA., Pimentel LY; Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts, USA., Rhoten MN; Department of Pharmacy Services, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, USA., Malloy R; Department of Pharmacy, Children's Hospital Colorado, Denver, Colorado, USA., Ting C; University of Chicago Medical Center, Chicago, Illinois, USA., Chhor R; Brigham and Women's Faulkner Hospital, Mass General Brigham, Jamaica Plain, Massachusetts, USA., Guerin JR; Brigham and Women's Faulkner Hospital, Mass General Brigham, Jamaica Plain, Massachusetts, USA., Schissel SL; Brigham and Women's Faulkner Hospital, Mass General Brigham, Jamaica Plain, Massachusetts, USA., Hoa B; Brigham and Women's Faulkner Hospital, Mass General Brigham, Jamaica Plain, Massachusetts, USA., Lio CH; Brigham and Women's Faulkner Hospital, Mass General Brigham, Jamaica Plain, Massachusetts, USA., Milewski K; Brigham and Women's Faulkner Hospital, Mass General Brigham, Jamaica Plain, Massachusetts, USA., Espinosa ME; Brigham and Women's Faulkner Hospital, Mass General Brigham, Jamaica Plain, Massachusetts, USA., Liu Z; Salem Hospital, Mass General Brigham, Salem, Massachusetts, USA., McHatton R; Salem Hospital, Mass General Brigham, Salem, Massachusetts, USA., Cunningham JW; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA., Jering KS; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA., Bertot JH; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Kaur G; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Ahmad A; Salem Hospital, Mass General Brigham, Salem, Massachusetts, USA., Akash M; Salem Hospital, Mass General Brigham, Salem, Massachusetts, USA., Davoudi F; Salem Hospital, Mass General Brigham, Salem, Massachusetts, USA., Hinrichsen MZ; Salem Hospital, Mass General Brigham, Salem, Massachusetts, USA., Rabin DL; Salem Hospital, Mass General Brigham, Salem, Massachusetts, USA., Gordan PL; Salem Hospital, Mass General Brigham, Salem, Massachusetts, USA., Roberts DJ; Salem Hospital, Mass General Brigham, Salem, Massachusetts, USA., Urma D; Salem Hospital, Mass General Brigham, Salem, Massachusetts, USA., McElrath EE; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Hinchey ED; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Choudhry NK; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Nekoui M; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA., Solomon SD; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA., Adler DS; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA., Vaduganathan M; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: mvaduganathan@bwh.harvard.edu.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2023 May 02; Vol. 81 (17), pp. 1680-1693. Date of Electronic Publication: 2023 Mar 06.
DOI:	10.1016/j.jacc.2023.02.029
Abstrakt:	Background: Scalable and safe approaches for heart failure guideline-directed medical therapy (GDMT) optimization are needed. Objectives: The authors assessed the safety and effectiveness of a virtual care team guided strategy on GDMT optimization in hospitalized patients with heart failure with reduced ejection fraction (HFrEF). Methods: In a multicenter implementation trial, we allocated 252 hospital encounters in patients with left ventricular ejection fraction ≤40% to a virtual care team guided strategy (107 encounters among 83 patients) or usual care (145 encounters among 115 patients) across 3 centers in an integrated health system. In the virtual care team group, clinicians received up to 1 daily GDMT optimization suggestion from a physician-pharmacist team. The primary effectiveness outcome was in-hospital change in GDMT optimization score (+2 initiations, +1 dose up-titrations, -1 dose down-titrations, -2 discontinuations summed across classes). In-hospital safety outcomes were adjudicated by an independent clinical events committee. Results: Among 252 encounters, the 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 optimization scores vs usual care (adjusted difference: +1.2; 95% CI: 0.7-1.8; P < 0.001). New initiations (44% vs 23%; absolute difference: +21%; P = 0.001) and net intensifications (44% vs 24%; absolute difference: +20%; P = 0.002) during hospitalization were higher in the virtual care team group, translating to a number needed to intervene of 5 encounters. Overall, 23 (21%) in the virtual care team group and 40 (28%) in usual care experienced 1 or more adverse events (P = 0.30). Acute kidney injury, bradycardia, hypotension, hyperkalemia, and hospital length of stay were similar between groups. Conclusions: 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 and scalable approach to optimize GDMT. Competing Interests: Funding Support and Author Disclosures Funding was provided by the Brigham Health Care Redesign Incubator and Startup Program, Brigham and Women’s Hospital, Mass General Brigham, Boston, Massachusetts. Dr Varshney has received consulting fees from Broadview Ventures. Dr Claggett has received consulting fees from Cardurion, Corvia, Cytokinetics, Intellia, and Novartis. Dr Eaton is employed at Brigham and Women’s hospital, but is also employed by Janssen Pharmaceuticals. Dr Cunningham has received consulting fees from Roche Diagnostics and Occlutech. Dr Choudhry has received research grant support to Brigham and Women‘s Hospital from Merck, Sanofi, AstraZeneca, CVS Health, and Medisafe. Dr Solomon has received research grants from Actelion, Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, Bristol Myers Squibb, Celladon, Cytokinetics, Eidos, Gilead, GlaxoSmithKline, Ionis, Lilly, Mesoblast, MyoKardia, National Institutes of Health/National Heart, Lung, and Blood Institute, Neurotronik, Novartis, NovoNordisk, Respicardia, Sanofi Pasteur, Theracos, and US2.AI; and has consulted for Abbott, Action, Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi Sankyo, GlaxoSmithKline, Lilly, Merck, Myokardia, Novartis, Roche, Theracos, Quantum Genomics, Cardurion, Janssen, Cardiac Dimensions, Tenaya, Sanofi-Pasteur, Dinaqor, Tremeau, CellProThera, Moderna, American Regent, and Sarepta. Dr Vaduganathan has received research grant support from, served on advisory boards for, or had speaker engagements with American Regent, Amgen, AstraZeneca, Bayer, Baxter Healthcare, Boehringer Ingelheim, Chiesi, Cytokinetics, Lexicon Pharmaceuticals, Novartis, Novo Nordisk, Pharmacosmos, Relypsa, Roche Diagnostics, Sanofi, and Tricog Health; and participates on clinical trial committees for studies sponsored by AstraZeneca, Galmed, Novartis, Bayer, Occlutech, and Impulse Dynamics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu