Bringing treatment for patients with heart failure with reduced ejection fraction (HFrEF) more into line with guidelines can be achieved without more in-person visits with a cardiologist. A recent study in JAMA Cardiology demonstrated that remote management of heart failure patients by navigators using algorithm-driven medication optimization programs helped patients reach recommended medication dosages within three months.
The researchers contacted cardiologists at a tertiary academic medical center who had patients with heart failure and an ejection fraction of no more than 40% to participate in the remote medication optimization study.
The 1028 eligible patients of the physicians who agreed were contacted by navigators. Of those, 197 opted into the study and had their medications adjusted by the navigators using a stepped titration algorithm based on heart failure guidelines issued by the American College of Cardiology and the American Heart Association. The 831 patients who declined formed the control group, which continued to receive usual care.
The navigators and their supervisors—a team including a pharmacist, nurse practitioner, and cardiologist specializing in heart failure—monitored patients’ laboratory tests, blood pressure, and symptoms. During the study, patients who achieved the guideline-recommended dosage of each medication class or reached their maximum tolerated dose were returned to their primary physician for continued care.
After three months, patients in the intervention group had increased their use of renin-angiotensin system antagonists by more than 20%, rising from 70.1% to 86.3%. Beta-blocker use increased from 77.2% to 91.9%. No significant increase was seen in mineralocorticoid receptor antagonists. Doses rose in all three medication categories for patients in the intervention group. No change was seen in the percentage of patients receiving any of the three categories of guideline-directed therapies or in the dosages of the medications in the control group.
“Remote titration of GDMT by navigators using encoded algorithms may represent an efficient, population-level strategy for rapidly closing the gap between guidelines and clinical practice in patients with HFrEF,” the researchers concluded.
