Performance On Guideline Directed Medical Therapy Remains Low In A Cluster-randomized Trial: Results From CONNECT-HF
Recommended Citation
Granger B, Devore A, Kaltenbach L, Fonarow G, Al-Khalidi H, Albert N, Lewis E, Butler J, Pina I, Heidenreich P, Allen L, Yancy C, Cooper L, Felker M, McRae A, Lanfear D, Harrison R, Disch M, Ariely D, Miller J, Granger C, Hernandez A. Performance On Guideline Directed Medical Therapy Remains Low In A Cluster-randomized Trial: Results From CONNECT-HF. 2022; :S43.
Document Type
Conference Proceeding
Publication Date
4-1-2022
Abstract
Introduction: : Clinicians caring for heart failure patients with reduced ejection fraction often fail to achieve optimal use of guideline-directed medical therapy (GDMT), which increases risk of readmission and/or death. Health system-level interventions have not consistently improved GDMT and factors associated with success in adopting GDMT are poorly defined. Objective: : Assess the relationship between hospital- and patient-level characteristics and health system performance on a composite score for GDMT at 12 months; and describe care delivery, care teams, and case mix associated with achieving optimal use of GDMT in practice. Methods: : Site-level composite quality scores were calculated at discharge and last or 12-monthvisit. Sites were characterized by performance using mean difference in quality composite score and were analyzed by performance tertile. Site performance prior to intervention was adjusted in the model as a fixed-effect. Results: : Among 150 sites, median 12-month improvement in GDMT performance was zero (Figure). Achievement of >50% target dose for ACE/ARB/ARNI and beta-blockers was modest, even among site in the top tertile of performance (median 29.57 [23, 41]; and 41.18 [29, 50]. At top scoring sites care teams included social workers and pharmacists and patients could afford medications and access current medication lists in the electronic health record. Conclusions: : Substantial gaps in site-level use of GDMT were found even among top tertile sites participating in CONNECT-HF. Hospitals may be a key resource for health systems, but their ability to drive quality-based metrics for care delivery processes post-discharge in HF remains low.
First Page
S43
