Remote monitoring titration clinic to implement guideline-directed therapy for heart failure patients with reduced ejection fraction: a pilot quality-improvement intervention
IntroductionGuideline-directed medical therapy (GDMT) is the recommended treatment for heart failure with reduced ejection fraction (HFrEF). However, the implementation remains limited, with suboptimal use and dosing. The study aimed to assess the feasibility and effect of a remote monitoring titrat...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-06-01
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| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1202615/full |
| _version_ | 1797800402898386944 |
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| author | Erick Romero Stella Yala Camryn Sellers-Porter Genevieve Lynch Veronicah Mwathi Yvette Hellier Svetlana Goldman Paulo Rocha Jeffrey R. Fine David Liem Julie T. Bidwell Imo Ebong Michael Gibson Martin Cadeiras |
| author_facet | Erick Romero Stella Yala Camryn Sellers-Porter Genevieve Lynch Veronicah Mwathi Yvette Hellier Svetlana Goldman Paulo Rocha Jeffrey R. Fine David Liem Julie T. Bidwell Imo Ebong Michael Gibson Martin Cadeiras |
| author_sort | Erick Romero |
| collection | DOAJ |
| description | IntroductionGuideline-directed medical therapy (GDMT) is the recommended treatment for heart failure with reduced ejection fraction (HFrEF). However, the implementation remains limited, with suboptimal use and dosing. The study aimed to assess the feasibility and effect of a remote monitoring titration program on GDMT implementation.MethodsHFrEF patients were randomly assigned to receive either usual care or a quality-improvement remote titration with remote monitoring intervention. The intervention group used wireless devices to transmit heart rate, blood pressure, and weight data daily, which were reviewed by physicians and nurses every 2–4 weeks. Medication tolerance was assessed via phone, and dosage instructions were given. This workflow was repeated until target doses were reached or further adjustments were not tolerated. A 4-GDMT score measured use and target dosage, with the primary endpoint being the score at 6 months follow-up.ResultsBaseline characteristics were similar (n = 55). A median of 85% of patients complied with transmitting device data every week. At the 6-month follow-up, the intervention group had a 4-GDMT score of 64.6% compared to 56.5% in the usual care group (p = 0.01), with a difference of 8.1% (95% CI: 1.7%–14.5%). Similar results were seen at the 12-month follow-up [difference 12.8% (CI: 5.0%–20.6%)]. The intervention group showed a positive trend in ejection fraction and natriuretic peptides, with no significant difference between groups.ConclusionsThe study suggests that a full-scale trial is feasible and that utilizing a remote titration clinic with remote monitoring has the potential to enhance the implementation of guideline-directed therapy for HFrEF. |
| first_indexed | 2024-03-13T04:33:39Z |
| format | Article |
| id | doaj.art-f7a35f74d6f84a56a60ecea74ee89787 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-13T04:33:39Z |
| publishDate | 2023-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-f7a35f74d6f84a56a60ecea74ee897872023-06-19T08:05:46ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-06-011010.3389/fcvm.2023.12026151202615Remote monitoring titration clinic to implement guideline-directed therapy for heart failure patients with reduced ejection fraction: a pilot quality-improvement interventionErick Romero0Stella Yala1Camryn Sellers-Porter2Genevieve Lynch3Veronicah Mwathi4Yvette Hellier5Svetlana Goldman6Paulo Rocha7Jeffrey R. Fine8David Liem9Julie T. Bidwell10Imo Ebong11Michael Gibson12Martin Cadeiras13Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, CA, United StatesDivision of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, CA, United StatesDivision of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, CA, United StatesDivision of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, CA, United StatesDivision of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, CA, United StatesDivision of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, CA, United StatesDivision of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, CA, United StatesDivision of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, CA, United StatesDepartment of Public Health Sciences, University of California Davis, Davis, CA, United StatesDivision of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, CA, United StatesBetty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, United StatesDivision of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, CA, United StatesDivision of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, CA, United StatesDivision of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, CA, United StatesIntroductionGuideline-directed medical therapy (GDMT) is the recommended treatment for heart failure with reduced ejection fraction (HFrEF). However, the implementation remains limited, with suboptimal use and dosing. The study aimed to assess the feasibility and effect of a remote monitoring titration program on GDMT implementation.MethodsHFrEF patients were randomly assigned to receive either usual care or a quality-improvement remote titration with remote monitoring intervention. The intervention group used wireless devices to transmit heart rate, blood pressure, and weight data daily, which were reviewed by physicians and nurses every 2–4 weeks. Medication tolerance was assessed via phone, and dosage instructions were given. This workflow was repeated until target doses were reached or further adjustments were not tolerated. A 4-GDMT score measured use and target dosage, with the primary endpoint being the score at 6 months follow-up.ResultsBaseline characteristics were similar (n = 55). A median of 85% of patients complied with transmitting device data every week. At the 6-month follow-up, the intervention group had a 4-GDMT score of 64.6% compared to 56.5% in the usual care group (p = 0.01), with a difference of 8.1% (95% CI: 1.7%–14.5%). Similar results were seen at the 12-month follow-up [difference 12.8% (CI: 5.0%–20.6%)]. The intervention group showed a positive trend in ejection fraction and natriuretic peptides, with no significant difference between groups.ConclusionsThe study suggests that a full-scale trial is feasible and that utilizing a remote titration clinic with remote monitoring has the potential to enhance the implementation of guideline-directed therapy for HFrEF.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1202615/fulltitrationGDMTremote monitoringHFrEFimplementationquality of care |
| spellingShingle | Erick Romero Stella Yala Camryn Sellers-Porter Genevieve Lynch Veronicah Mwathi Yvette Hellier Svetlana Goldman Paulo Rocha Jeffrey R. Fine David Liem Julie T. Bidwell Imo Ebong Michael Gibson Martin Cadeiras Remote monitoring titration clinic to implement guideline-directed therapy for heart failure patients with reduced ejection fraction: a pilot quality-improvement intervention Frontiers in Cardiovascular Medicine titration GDMT remote monitoring HFrEF implementation quality of care |
| title | Remote monitoring titration clinic to implement guideline-directed therapy for heart failure patients with reduced ejection fraction: a pilot quality-improvement intervention |
| title_full | Remote monitoring titration clinic to implement guideline-directed therapy for heart failure patients with reduced ejection fraction: a pilot quality-improvement intervention |
| title_fullStr | Remote monitoring titration clinic to implement guideline-directed therapy for heart failure patients with reduced ejection fraction: a pilot quality-improvement intervention |
| title_full_unstemmed | Remote monitoring titration clinic to implement guideline-directed therapy for heart failure patients with reduced ejection fraction: a pilot quality-improvement intervention |
| title_short | Remote monitoring titration clinic to implement guideline-directed therapy for heart failure patients with reduced ejection fraction: a pilot quality-improvement intervention |
| title_sort | remote monitoring titration clinic to implement guideline directed therapy for heart failure patients with reduced ejection fraction a pilot quality improvement intervention |
| topic | titration GDMT remote monitoring HFrEF implementation quality of care |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1202615/full |
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