Nadine Zawadzki, Ph.D., M.P.H., Director, gave a podium presentation on her research examining the effect of a collaborate care virtual pharmacy service to optimize guideline-directed medical therapy and reduce emergent and acute care utilization in Medicare patients with heart failure with reduced ejection fraction at the American College of Cardiology 2024 conference in Atlanta, GA on April 7, 2024. The study abstract is below.
Background: The study objective was to determine the effectiveness of telehealth delivered pharmacist co-management of patients with heart failure with reduced ejection fraction (HFrEF) to achieve optimal guideline-directed medical therapy (GDMT) and reduce emergent and acute hospital care.
Methods: This prospective cohort study, spanning March 2022 to March 2023, used a difference-in-difference approach to compare outcomes between patients receiving intervention and usual care. Intervention patients were Medicare recipients age 65+ with HFrEF covered by the sponsoring healthcare network’s Medicare risk-sharing agreement. Comparison patients were clinically similar Medicare recipients with HFrEF served by the same network. Eligible intervention patients were co-managed by specially trained pharmacists via frequent telehealth visits with the focus of GDMT optimization in addition to usual care. Intention to treat analysis included all patients who initially consented. Data was extracted from electronic health records including contracted prescription database. Primary analysis applied inverse propensity of treatment weighting to estimate treatment effects, conditioned on multiple patient baseline clinical and demographic factors.
Results: A total of 190 treatment and 277 comparison patients met eligibility criteria; 26 intervention patients withdrew. Both groups were statistically comparable, with modest differences. The intervention group was associated with a 74% relative risk (RR) reduction in cardiac hospitalizations 6 months post-intervention (RR=0.26, p=0.026). Based on not yet complete data, cardiac hospitalization reduction appears sustained at 12-months (RR=0.25, p=0.013). There was no significant reduction in all-cause or cardiac emergency room visits. Achieving 4 GDMT classes increased significantly within 6-months (OR 2.27, p=0.005). There was no significant increase in GDMT-attributable safety events, save for systolic blood pressure <90mmHg.
Conclusion: Pharmacist telehealth co-management of HFrEF patients focused on GDMT optimization achieved dramatic reductions in cardiac hospitalizations at 6 months.
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