Abstract Body (Do not enter title and authors here): Introduction: Heart failure (HF) poses a major public health challenge in the United States, and patients in rural areas experience worse HF outcomes. Telemedicine has effectively provided access to specialty cardiovascular care to hospitalized patients in rural hospitals. A better understanding of care quality among patients hospitalized with HF in rural hospitals is needed to improve outcomes in this vulnerable population.

Methods: We developed a virtual registry of patients hospitalized with acute HF in rural hospitals in collaboration with the American Heart Association (Grant: 23DSG1154425) and Access Telecare, a nationwide telehealth provider. Patients hospitalized to 13 rural hospitals across Texas, Indiana, South Carolina, and New Mexico are prospectively enrolled. Patients with acute HF are identified with an ICD 10 code for HF in the primary or first secondary position. Demographics, in-hospital care, post-discharge follow-up, and discharge utilization of GDMT (renin-angiotensin-aldosterone inhibitors (RAASi), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT2i) for HFrEF; RAASi, MRA, SGLT2i for HFpEF) were abstracted from the electronic medical record.

Results: As of June 6, 2024, 254 patients (mean age 72 y, 40.2% female, 7.5% Black) were included (Table). 42.1% had HFrEF. 37% underwent LVEF assessment during the hospital stay. 74.4% of all patients received any GDMT at any dose, 4.7% received all classes of GDMT at any dose, and only 1.2% were prescribed GDMT at optimal doses. Among patients with HFrEF, evidence-based (vs non-evidence-based) BB was 58.9% and 15%, respectively. Furthermore, 74.7% of patients with HFrEF received ≤ 2 GDMT classes. At discharge, 0.4% of patients were referred for cardiac rehabilitation and 41.3% had a follow-up visit scheduled. Among patients with a history of atrial fibrillation/flutter, the rate of anticoagulation was 57.3%.

Conclusion: There are considerable implementation gaps in GDMT and post-discharge care for patients with HF hospitalized in rural areas. Effective and scalable telemedicine interventions are needed to improve the uptake of GDMT among hospitalized HF patients in rural areas.