Impact Of Atrial Fibrillation On Readmission After LVAD Implantation: Insight From National Readmission Database.
HFSA ePoster Library. Shatla I. 09/10/21; 343354; 131
Islam Shatla
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Abstract
Discussion Forum (0)
Introduction: A large proportion of patients with heart failure with reduced ejection fraction (HFrEF) receive suboptimal doses of Guideline Directed Medical Therapy (GDMT). We hypothesize that a titration clinic assisted by non-invasive telemonitoring results in greater GDMT optimization.
Methods: Patients were randomized to GDMT delivered by a titration clinic assisted by non-invasive telemonitoring vs. usual care. Eligibility included HFrEF on at least one GDMT medication at <50% of target dose. Patients in the telemonitoring assisted group used wireless devices to transmit heart rate, blood pressure, and weight daily from their homes to a HIPAA compliant platform. HF nurses, pharmacists, and physicians reviewed the data along with clinical and biochemical profile every 2-3 weeks to recommend treatment optimization following ACC/AHA Guidelines. This workflow was repeated cyclically until patients reached target doses or further adjustments were not possible due to intolerance. Control patients had clinical encounters and phone calls as determined by treating provider. The primary outcome was the within-group percentage (%) of target dose achieved at 6 months compared to baseline for angiotensin receptor-neprilysin inhibitor, angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ARNI/ACEI/ARB), β-blockers (BB), and mineralocorticoid receptor antagonists (MRA). Wilcoxon one-tailed signed-rank test was used for analysis.
Results: Participants (n=49) were randomized to telemonitoring (n=24) or usual care (n=25), baseline characteristics between groups including age, sex, NYHA class, LVEF, BNP, and GFR were similar overall. Patients in the telemonitoring group had a change in target dose % [±SD] from baseline to 6 months of 25.7% [20.8] to 52.8% [27.1] (P< 0.01) for ARNI/ACEI/ARB, 51.7% [47.5] to 73.1% [42.8] (P< 0.03) for BB, and 59% [42.6] to 109% [71.7] (P< 0.01) for MRA. In the control group, changes at six months were 30% [21.6] to 33.4% [21.2] (P= 0.34) for ARNI/ARA/ACE, 42.5% [40.6] to 50% [40.8] (P= 0.16) for BB, and 92.1% [47.9] to 110.5% [87.5] (P= 0.5) for MRA.
Conclusions: A titration clinic assisted by non-invasive telemonitoring is feasible and may improve rapid optimization of GDMT in clinical practice. A larger study is needed to confirm our findings and assess the impact on clinical outcomes.
Methods: Patients were randomized to GDMT delivered by a titration clinic assisted by non-invasive telemonitoring vs. usual care. Eligibility included HFrEF on at least one GDMT medication at <50% of target dose. Patients in the telemonitoring assisted group used wireless devices to transmit heart rate, blood pressure, and weight daily from their homes to a HIPAA compliant platform. HF nurses, pharmacists, and physicians reviewed the data along with clinical and biochemical profile every 2-3 weeks to recommend treatment optimization following ACC/AHA Guidelines. This workflow was repeated cyclically until patients reached target doses or further adjustments were not possible due to intolerance. Control patients had clinical encounters and phone calls as determined by treating provider. The primary outcome was the within-group percentage (%) of target dose achieved at 6 months compared to baseline for angiotensin receptor-neprilysin inhibitor, angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ARNI/ACEI/ARB), β-blockers (BB), and mineralocorticoid receptor antagonists (MRA). Wilcoxon one-tailed signed-rank test was used for analysis.
Results: Participants (n=49) were randomized to telemonitoring (n=24) or usual care (n=25), baseline characteristics between groups including age, sex, NYHA class, LVEF, BNP, and GFR were similar overall. Patients in the telemonitoring group had a change in target dose % [±SD] from baseline to 6 months of 25.7% [20.8] to 52.8% [27.1] (P< 0.01) for ARNI/ACEI/ARB, 51.7% [47.5] to 73.1% [42.8] (P< 0.03) for BB, and 59% [42.6] to 109% [71.7] (P< 0.01) for MRA. In the control group, changes at six months were 30% [21.6] to 33.4% [21.2] (P= 0.34) for ARNI/ARA/ACE, 42.5% [40.6] to 50% [40.8] (P= 0.16) for BB, and 92.1% [47.9] to 110.5% [87.5] (P= 0.5) for MRA.
Conclusions: A titration clinic assisted by non-invasive telemonitoring is feasible and may improve rapid optimization of GDMT in clinical practice. A larger study is needed to confirm our findings and assess the impact on clinical outcomes.
Introduction: A large proportion of patients with heart failure with reduced ejection fraction (HFrEF) receive suboptimal doses of Guideline Directed Medical Therapy (GDMT). We hypothesize that a titration clinic assisted by non-invasive telemonitoring results in greater GDMT optimization.
Methods: Patients were randomized to GDMT delivered by a titration clinic assisted by non-invasive telemonitoring vs. usual care. Eligibility included HFrEF on at least one GDMT medication at <50% of target dose. Patients in the telemonitoring assisted group used wireless devices to transmit heart rate, blood pressure, and weight daily from their homes to a HIPAA compliant platform. HF nurses, pharmacists, and physicians reviewed the data along with clinical and biochemical profile every 2-3 weeks to recommend treatment optimization following ACC/AHA Guidelines. This workflow was repeated cyclically until patients reached target doses or further adjustments were not possible due to intolerance. Control patients had clinical encounters and phone calls as determined by treating provider. The primary outcome was the within-group percentage (%) of target dose achieved at 6 months compared to baseline for angiotensin receptor-neprilysin inhibitor, angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ARNI/ACEI/ARB), β-blockers (BB), and mineralocorticoid receptor antagonists (MRA). Wilcoxon one-tailed signed-rank test was used for analysis.
Results: Participants (n=49) were randomized to telemonitoring (n=24) or usual care (n=25), baseline characteristics between groups including age, sex, NYHA class, LVEF, BNP, and GFR were similar overall. Patients in the telemonitoring group had a change in target dose % [±SD] from baseline to 6 months of 25.7% [20.8] to 52.8% [27.1] (P< 0.01) for ARNI/ACEI/ARB, 51.7% [47.5] to 73.1% [42.8] (P< 0.03) for BB, and 59% [42.6] to 109% [71.7] (P< 0.01) for MRA. In the control group, changes at six months were 30% [21.6] to 33.4% [21.2] (P= 0.34) for ARNI/ARA/ACE, 42.5% [40.6] to 50% [40.8] (P= 0.16) for BB, and 92.1% [47.9] to 110.5% [87.5] (P= 0.5) for MRA.
Conclusions: A titration clinic assisted by non-invasive telemonitoring is feasible and may improve rapid optimization of GDMT in clinical practice. A larger study is needed to confirm our findings and assess the impact on clinical outcomes.
Methods: Patients were randomized to GDMT delivered by a titration clinic assisted by non-invasive telemonitoring vs. usual care. Eligibility included HFrEF on at least one GDMT medication at <50% of target dose. Patients in the telemonitoring assisted group used wireless devices to transmit heart rate, blood pressure, and weight daily from their homes to a HIPAA compliant platform. HF nurses, pharmacists, and physicians reviewed the data along with clinical and biochemical profile every 2-3 weeks to recommend treatment optimization following ACC/AHA Guidelines. This workflow was repeated cyclically until patients reached target doses or further adjustments were not possible due to intolerance. Control patients had clinical encounters and phone calls as determined by treating provider. The primary outcome was the within-group percentage (%) of target dose achieved at 6 months compared to baseline for angiotensin receptor-neprilysin inhibitor, angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ARNI/ACEI/ARB), β-blockers (BB), and mineralocorticoid receptor antagonists (MRA). Wilcoxon one-tailed signed-rank test was used for analysis.
Results: Participants (n=49) were randomized to telemonitoring (n=24) or usual care (n=25), baseline characteristics between groups including age, sex, NYHA class, LVEF, BNP, and GFR were similar overall. Patients in the telemonitoring group had a change in target dose % [±SD] from baseline to 6 months of 25.7% [20.8] to 52.8% [27.1] (P< 0.01) for ARNI/ACEI/ARB, 51.7% [47.5] to 73.1% [42.8] (P< 0.03) for BB, and 59% [42.6] to 109% [71.7] (P< 0.01) for MRA. In the control group, changes at six months were 30% [21.6] to 33.4% [21.2] (P= 0.34) for ARNI/ARA/ACE, 42.5% [40.6] to 50% [40.8] (P= 0.16) for BB, and 92.1% [47.9] to 110.5% [87.5] (P= 0.5) for MRA.
Conclusions: A titration clinic assisted by non-invasive telemonitoring is feasible and may improve rapid optimization of GDMT in clinical practice. A larger study is needed to confirm our findings and assess the impact on clinical outcomes.
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