Medical therapy

Outpatient Management of Guideline-Directed Medical Therapy for Heart Failure Using Telehealth: A Comparison of Office, Video, and Telephone Visits

This article was originally published here

Card J Failed Mar 19, 2022: S1071-9164(22)00449-3. doi:10.1016/j.cardfail.2022.02.016. Online ahead of print.

ABSTRACT

BACKGROUND: There are limited data regarding the management of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) with virtual visits versus office visits. We sought to compare GDMT modifications (angiotensin converting enzyme inhibitors, angiotensin-II receptor blockers, angiotensin neprilysin receptor blockers, mineralocorticoid receptor antagonist and cotransporter blocker sodium-glucose-2) and loop diuretics depending on the type of visit.

METHODS: This study included 13,481 outpatient visits performed for 5,439 unique patients with HFrEF between March 16, 2020 and March 15, 2021. The rates of initiation and termination of GDMT were documented, and multivariable logistic regression was was performed to test associations with outcomes between visiting modes.

RESULTS: Medication initiation rates were higher in office (11.7%) than with video (9.6%) or telephone (7.2%) visits. In the adjusted multivariate analysis, initiation of at least 1 GDMT class was similar between office visits and video visits (adj OR 0.97; 95% CI 0.82-1.14; p=0.703 ). Telephone visits were associated with less frequent initiation of at least 1 GDMT class compared to office visits (OR adj 0.64; 0.55-0.75; p

CONCLUSIONS: GDMT initiation for HFrEF was similar between office and video visits and lower with telephone visits, while loop diuretic initiation was less common in both types of virtual visits. This data suggests that video streaming capabilities should be encouraged for virtual tours.

PMID:35318127 | DOI:10.1016/j.cardfail.2022.02.016