Abstract 14872: A Nationwide Telehealth Heart Failure Program: Can Remote Patient Monitoring and Guideline Directed Treatment Protocols Benefit HFpEF Management?
David I Feldman, Dmitri Repnikov, Marcus L Campbell, Sarine Babikian, Diana Sanchez, Ashwyn Sharma, Randall Curnow, Theodore Feldman, Marat Fudim- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Introduction: Heart failure (HF) patients experience unnecessary morbidity and mortality due to inadequate use and dose of GDMT. While RPM has proven to help HFrEF patients achieve higher rates of GDMT, its value in optimizing comorbidities and GDMT in HFpEF patients is less clear.
Hypothesis: A team of multi-disciplinary HF clinicians can leverage RPM and guideline directed treatment protocols to bridge the gaps in HFpEF management.
Methods: Cadence enrolled Medicare patients with HFpEF across 11 states into a virtual HF program from December 2021 to April 2023. Eligible patients had either an ICD-10 code for diastolic HF, diastolic dysfunction on TTE, or an EF>50% and a prior HFH or active treatment for HF by their clinician. Patients were given a cellular enabled BP cuff and weight scale to measure vitals. Coupling a technology enabled vitals and symptoms tracker with a guideline directed clinical protocol algorithm, symptom, vital and medication optimization was achieved.
Results: Two-hundred fifteen patients (mean (SD) values: age 76 (9); white 64%, women 49%; BP 141/79 (9/6) mmHg; EF 60% (0.1)) were followed for a mean of 223 (82) days. Comorbidities, including DM (41%), AF (53%) and HTN (92%), were highly prevalent. There was a statistically significant reduction in BP and weight, but not heart rate (BP: -11/6 mmHg, Wt -4 lbs; p<0.001). Patient engagement information, including number of vitals recorded, clinical visits and phone calls completed, and high acuity clinical alerts resolved, is depicted in Figure 1A. There was a 286% and 71% increase in percentage of patients on a SGLT2i and MRA, respectively, at follow-up compared to baseline (SGLT2i: 15 (7%) vs. 44 (20%); p<0.001, MRA: 30 (14%) vs. 50 (24%); p<0.05). Additional changes in use and dose of GDMT are shown in Figure 1B.
Conclusion: A telehealth HF program that utilizes RPM and technology enabled treatment protocols can meaningfully improve HF-specific vitals and rates of GDMT in patients with HFpEF.