{"id":138298,"date":"2024-04-09T10:00:10","date_gmt":"2024-04-09T14:00:10","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=138298"},"modified":"2024-04-09T10:00:10","modified_gmt":"2024-04-09T14:00:10","slug":"hozho-phone-based-gdmt-initiation-and-uptitration-feasible-and-effective-among-hfref-patients-in-navajo-nation","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=138298","title":{"rendered":"Ho\u0301zho\u0301: Phone-based GDMT Initiation and Uptitration Feasible and Effective among HFrEF patients in Navajo Nation"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Key Points:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">GDMT utilization is suboptimal among American Indian patients with HFrEF in Navajo Nation.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">In this pragmatic, stepped-wedge, randomized clinical trial, a telehealth intervention using telephone calls and remote BP monitoring was significantly more effective than usual care in rapid GDMT optimization.\u00a0\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">\u00a0<\/span><!--more--><\/p>\n<p><span style=\"font-weight: 400;\">Guideline directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) improves outcomes and survival.\u00a0 However, many American Indian patients have limited access to care and cardiovascular specialists, leading to GDMT underutilization.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">On April 7, 2024, the principal results of the \u201cHo\u0301zho\u0301 (Heart Failure Optimization At Home To Improve Outcomes): A Pragmatic Clinical Trial Of Telephone-based Guideline-directed Medical Therapy Optimization In Navajo Nation\u201d were presented at ACC Scientific Sessions 2024.\u00a0 The purpose of this study was to evaluate a telehealth model for GDMT initiation and uptitration in rural Navajo Nation using phone calls and a home blood pressure cuff, with a goal to establish quadruple therapy by 30 days.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">This pragmatic trial randomized patients with HFrEF (LVEF &lt;= 40%) to the telehealth model or usual care in a stepped-wedge fashion over 5 time-points, 30 days apart, until all patients crossed over to the telehealth arm by day 150.\u00a0 Patients were included if they received care at one of two participating Indian Health Service (IHS) facilities, had an LVEF &lt;= 40%, and were seen in the clinic in the prior 12 months.\u00a0 The primary outcome was the increase in number of GDMT classes filled at a pharmacy at 30 days post-randomization.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Of the 103 enrolled patients, the median age was 65 years, 71% were female, 100% were American Indian, 61% had diabetes, 48% had coronary artery disease.\u00a0 The median LVEF was 32%.\u00a0 At baseline, 94% of patients were on beta blocker, 87% were on an ACE\/ARB or ARNI, 40% were on an MRA, and 44% were on an SGLT2i. \u00a0 Patients in the intervention arm were significantly more likely to undergo the addition of a GDMT class at 30 days compared to usual care (OR 12.99 [95% CI 6.87-24.53], P &lt;0.001), with a number needed to treat of only 2.\u00a0 Heart failure hospitalizations were also significantly lower in the intervention arm (1.3% vs 4.3%, OR 0.30 [95% CI 0.11-0.85], p=0.024), and there was no difference in total adverse events (6.6% vs. 5.0%, p=0.506).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Limitations include a small sample size from a single health care system with no-cost medications, which limits generalizability.\u00a0 Longer term adherence and outcomes were not assessed in the present study.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Lauren A. Eberly MD, MPH, from the University of Pennsylvania, concluded: \u201cA telehealth model leveraging phone-based GDMT optimization with remote telemonitoring led to significant and rapid increases in the uptake of GDMT.\u00a0 This low cost-strategy could be expanded to other rural settings where access to care is limited.\u201d\u00a0 <\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Key Points: GDMT utilization is suboptimal among American Indian patients with HFrEF in Navajo Nation. In this pragmatic, stepped-wedge, randomized clinical trial, a telehealth intervention using telephone calls and remote BP monitoring was significantly more effective than usual care in rapid GDMT optimization.\u00a0\u00a0 \u00a0<\/p>\n","protected":false},"author":40603,"featured_media":138299,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[888,8],"tags":[889,45,47,185],"ppma_author":[1029],"class_list":{"0":"post-138298","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-acc-2024","8":"category-news","9":"tag-acc-2024","10":"tag-conference","11":"tag-featured","12":"tag-news","13":"author-leah-kosyakovsky"},"authors":[{"term_id":1029,"user_id":40603,"is_guest":0,"slug":"leah-kosyakovsky","display_name":"Leah Kosyakovsky","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/864bde69f6f1f80e91e4a97f0a0ba8daa64c2bb702be09ed787444c7dfa045bb?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138298","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40603"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=138298"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138298\/revisions"}],"predecessor-version":[{"id":138300,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138298\/revisions\/138300"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/138299"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=138298"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=138298"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=138298"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=138298"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}