HFSA ePoster Library

Abstract

 ePoster Impacting Guideline Directed Medical Therapy Optimization With Story Health
Introduction:
Heart failure (HF) is a significant contributor to morbidity and mortality. Efforts to improve guideline directed medical therapy (GDMT) have been associated with reduction in HF hospitalization and mortality. Story Health is a company designed to interface with electronic medical records and provide a link between clinicians and patients to optimize GDMT. We aim to assess the effectiveness of Story Health GDMT optimization of patients with HFrEF in achieving > 50% of target dose at 90 days. Hypothesis: We hypothesize that patients enrolled in the Story Health HF optimization program will achieve higher rates of successful dosing (> 50% of targeted dose) for beta blockers (BB), angiotensin converting enzyme inhibitors (ACEI) / angiotensin receptor blockers (ARB) / angiotensin receptor blockers and neprilysin inhibitors (ARNI) and mineralocorticoid receptor antagonists (MRA) at 90 days compared to baseline.

Methods:
HFrEF patients enrolled and followed for at least 90 days were included in this study. They received blood pressure (BP) cuffs and weight scales that transmitted their BP, heart rate and weight to a secure server managed by Story Health. A titration schedule was built by enrolling HF cardiologists. Medication adjustments were made biweekly with prompts by a Story Health coach (cardiac trained nurse) to the clinician per the titration schedule. Coaches contacted patients regularly for symptoms / vitals assessments, and for labs as scheduled. Clinicians reviewed patients' progress in a Story Health integrated EMR site where all data could be viewed centrally. Clinicians then approved next GDMT optimization steps or made further adjustments as necessary. Patients' baseline medication regimens were recorded for the four medication classes in GDMT (BB, ACEI/ARB/ARNI, MRA, SGTL2i) and further subdivided into 3 categories: 1) successful (50-100% of target dose), 2) on some dose (< 50% of target dose), 3) on no dose. Medication regimens were similarly assessed at the end of 90 days. Percent of patients with successful dosing was then assessed for each drug class at baseline and day 90. Absolute changes in GDMT medication classes were then assessed. Results: 100 patients were enrolled between June 2021 to March 2022. 10 were lost to follow-up. 55 patients completed at least 90 days of follow-up during this period. At enrollment, 36%, 16%, 29% and 30% of patients were on successful dose for BB, ACEI/ARB/ARNI, MRA and SGLT2i respectively. At 90 days, successful dose achieved for same drug classes was 63%, 63%, 58%, and 73% respectively. Absolute increase in successful dosing was 27%, 47%, 29%, and 42% respectively (Figure 1).

Conclusion:
The Story Health GDMT titration program was effective in increasing percentage of HFrEF patients with successful GDMT dosing at 90 days.

Introduction:
Heart failure (HF) is a significant contributor to morbidity and mortality. Efforts to improve guideline directed medical therapy (GDMT) have been associated with reduction in HF hospitalization and mortality. Story Health is a company designed to interface with electronic medical records and provide a link between clinicians and patients to optimize GDMT. We aim to assess the effectiveness of Story Health GDMT optimization of patients with HFrEF in achieving > 50% of target dose at 90 days. Hypothesis: We hypothesize that patients enrolled in the Story Health HF optimization program will achieve higher rates of successful dosing (> 50% of targeted dose) for beta blockers (BB), angiotensin converting enzyme inhibitors (ACEI) / angiotensin receptor blockers (ARB) / angiotensin receptor blockers and neprilysin inhibitors (ARNI) and mineralocorticoid receptor antagonists (MRA) at 90 days compared to baseline.

Methods:
HFrEF patients enrolled and followed for at least 90 days were included in this study. They received blood pressure (BP) cuffs and weight scales that transmitted their BP, heart rate and weight to a secure server managed by Story Health. A titration schedule was built by enrolling HF cardiologists. Medication adjustments were made biweekly with prompts by a Story Health coach (cardiac trained nurse) to the clinician per the titration schedule. Coaches contacted patients regularly for symptoms / vitals assessments, and for labs as scheduled. Clinicians reviewed patients' progress in a Story Health integrated EMR site where all data could be viewed centrally. Clinicians then approved next GDMT optimization steps or made further adjustments as necessary. Patients' baseline medication regimens were recorded for the four medication classes in GDMT (BB, ACEI/ARB/ARNI, MRA, SGTL2i) and further subdivided into 3 categories: 1) successful (50-100% of target dose), 2) on some dose (< 50% of target dose), 3) on no dose. Medication regimens were similarly assessed at the end of 90 days. Percent of patients with successful dosing was then assessed for each drug class at baseline and day 90. Absolute changes in GDMT medication classes were then assessed. Results: 100 patients were enrolled between June 2021 to March 2022. 10 were lost to follow-up. 55 patients completed at least 90 days of follow-up during this period. At enrollment, 36%, 16%, 29% and 30% of patients were on successful dose for BB, ACEI/ARB/ARNI, MRA and SGLT2i respectively. At 90 days, successful dose achieved for same drug classes was 63%, 63%, 58%, and 73% respectively. Absolute increase in successful dosing was 27%, 47%, 29%, and 42% respectively (Figure 1).

Conclusion:
The Story Health GDMT titration program was effective in increasing percentage of HFrEF patients with successful GDMT dosing at 90 days.

By clicking “Accept Terms & all Cookies” or by continuing to browse, you agree to the storing of third-party cookies on your device to enhance your user experience and agree to the user terms and conditions of this learning management system (LMS).

Cookie Settings
Accept Terms & all Cookies