Performance On Guideline Directed Medical Therapy Remains Low In A Cluster-randomized Trial: Results From CONNECT-HF

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Conference Proceeding

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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.

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