Romero Erick, Yala Stella, Sellers-Porter Camryn, Lynch Genevieve, Mwathi Veronicah, Hellier Yvette, Goldman Svetlana, Rocha Paulo, Fine Jeffrey R, Liem David, Bidwell Julie T, Ebong Imo, Gibson Michael, Cadeiras Martin
Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, CA, United States.
Department of Public Health Sciences, University of California Davis, Davis, CA, United States.
Front Cardiovasc Med. 2023 Jun 19;10:1202615. doi: 10.3389/fcvm.2023.1202615. eCollection 2023.
Guideline-directed medical therapy (GDMT) is the recommended treatment for heart failure with reduced ejection fraction (HFrEF). However, the implementation remains limited, with suboptimal use and dosing. The study aimed to assess the feasibility and effect of a remote monitoring titration program on GDMT implementation.
HFrEF patients were randomly assigned to receive either usual care or a quality-improvement remote titration with remote monitoring intervention. The intervention group used wireless devices to transmit heart rate, blood pressure, and weight data daily, which were reviewed by physicians and nurses every 2-4 weeks. Medication tolerance was assessed via phone, and dosage instructions were given. This workflow was repeated until target doses were reached or further adjustments were not tolerated. A 4-GDMT score measured use and target dosage, with the primary endpoint being the score at 6 months follow-up.
Baseline characteristics were similar ( = 55). A median of 85% of patients complied with transmitting device data every week. At the 6-month follow-up, the intervention group had a 4-GDMT score of 64.6% compared to 56.5% in the usual care group ( = 0.01), with a difference of 8.1% (95% CI: 1.7%-14.5%). Similar results were seen at the 12-month follow-up [difference 12.8% (CI: 5.0%-20.6%)]. The intervention group showed a positive trend in ejection fraction and natriuretic peptides, with no significant difference between groups.
The study suggests that a full-scale trial is feasible and that utilizing a remote titration clinic with remote monitoring has the potential to enhance the implementation of guideline-directed therapy for HFrEF.
指南指导的药物治疗（GDMT）是射血分数降低的心力衰竭（HFrEF）的推荐治疗方法。然而，其实施仍然有限，存在使用和剂量未达最佳的情况。本研究旨在评估远程监测滴定程序对GDMT实施的可行性和效果。
HFrEF患者被随机分配接受常规护理或通过远程监测干预进行质量改进的远程滴定。干预组使用无线设备每天传输心率、血压和体重数据，医生和护士每2 - 4周对这些数据进行审查。通过电话评估药物耐受性，并给出剂量指导。重复此工作流程，直到达到目标剂量或无法耐受进一步调整。一个4 - GDMT评分衡量使用情况和目标剂量，主要终点是6个月随访时的评分。
基线特征相似（n = 55）。中位数为85%的患者每周遵守传输设备数据。在6个月随访时，干预组的4 - GDMT评分为64.6%，而常规护理组为56.5%（P = 0.01），差异为8.1%（95% CI：1.7% - 14.5%）。在12个月随访时也观察到类似结果[差异12.8%（CI：5.0% - 20.6%）]。干预组在射血分数和利钠肽方面呈现积极趋势，组间无显著差异。
该研究表明全面试验是可行的，并且利用带有远程监测的远程滴定诊所有可能加强对HFrEF的指南指导治疗的实施。
