Abstract Body (Do not enter title and authors here): Background
Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) improves outcomes and quality of life. It includes renin-angiotensin system inhibitors (ACE inhibitors, ARBs, ARNi, MRAs), beta-blockers, and SGLT2 inhibitors, which reduce deaths and hospitalizations. Many patients are undertreated, with non-optimized regimens. Few studies compare virtual versus in-office visits for GDMT management. This study aims to assess the efficacy of a virtual multidisciplinary GDMT team in optimizing therapy for HFrEF patients.
Methodology
On March 19, 2024, we conducted searches in PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Virtual Health Library (VHL) to identify relevant clinical trials. We included trials comparing virtual consultations with in-office consultations to optimize GDMT, focusing on changes in the usage of GDMT medications (ACEI/ARBs/ARNIs, MRA, BB, and SGLT2) and cardiac hospitalization rates. We used STATA 18 with a DerSimonian random effects model to calculate effect size. Analyses were performed on pre- and post-data of both groups using odds ratios, and we compared cardiovascular hospitalization rates in the post-data using odds ratios (OR).
Result
The database search yielded 2,401 studies, of which 8 studies with a total of 15,758 participants were included. There was no statistically significant difference in GDMT usage between in-office and virtual consultations for all drugs. For in-office visits, the OR were: SGLT2, OR 1.30 (95% CI: 0.85 - 1.99); beta blockers, OR 1.13 (95% CI: 0.92 - 1.40); MRA, OR 1.12 (95% CI: 1.05 - 1.19); and ACE, ARB, or ARN inhibitors, OR 1.06 (95% CI: 0.96 - 1.17). For virtual consultations, the OR were: SGLT2, OR 1.72 (95% CI: 0.87 - 3.38); beta blockers, OR 1.61 (95% CI: 0.96 - 2.73); MRA, OR 1.17 (95% CI: 0.98 - 1.40); and ACE, ARB, and ARN inhibitors, OR 1.24 (95% CI: 0.85 - 1.80). There was no statistically significant difference in cardiovascular hospitalization events between virtual and in-office visits, with an OR of 0.74 (95% CI: 0.45 - 1.21).
Conclusion
There were no differences between the two groups in optimizing GDMT usage. However, GDMT medications remain underutilized in heart failure patients despite their proven benefits in reducing morbidity and mortality. More policies and innovative strategies are needed to optimize their usage. Further investigation is crucial for refining clinical approaches and enhancing patient care.