Scalable Strategies to Heart Health

New Mass General Brigham study finds ways to improve outcomes for heart failure patients. 

May 2023 – The Journal of Healthcare Contracting

A recent study conducted by Mass General Brigham, a Massachusetts-based integrated academic healthcare system, looked at a new approach to improve medical therapies to reduce the risk of worsening symptoms and extend the lives of patients with heart failure. A virtual care team of physicians and pharmacists was put in place to help guide treatment strategies for these patients, while looking for a scalable approach to help adopt these therapies into general practice.

IMPLEMENT-HF (Implementation of Medical Therapy in Hospitalized Patients with Heart with Reduced Ejection Fraction) started at Brigham Women’s Hospital before expanding to include patients at Brigham and Women’s Faulkner Hospital and Salem Hospital.

Dale Adler, MD, co-author of the study and executive vice chair of the BWH Department of Medicine and a specialist in Cardiovascular Medicine, said in a press release, “What we learned when we took this to the community hospitals was that cardiologists were eager to work with us to improve adoption of guideline-directed medical therapy to help their patients. Many physicians had read recent studies about therapy for heart failure and knew the ideal therapy combinations, but they hadn’t had the chance to implement them with supervision. This study and the virtual care team we assembled gave them the opportunity to do so.”

The patients included in the study were admitted to one of the hospitals between October 2021 and June 2022, whether they were admitted for a heart failure-related condition or not. The condition in question is heart failure with reduced ejection fraction, which is where the heart pumps less blood than the body needs. There were 198 unique patients and 252 clinical encounters across all three hospitals included in the study. Of this group, 145 encounters received usual care while the virtual care team provided guidance for 107 other patients.

That virtual team is a critical piece of the puzzle, consisting of a centralized physician, study staff and local pharmacist at each site where patient cases were evaluated daily to improve GDMT practices. They made 187 unique recommendations based on the patient data they were working with, which allowed for more patients to initiate new treatment or receive a more appropriate dosing of GDMT than before.

“We have been interested in identifying the most effective, safe, and scalable strategies to better implement medical advances in the treatment of heart failure and other cardiometabolic conditions,” said lead author Ankeet S. Bhatt, MD, MBA, ScM, a former BWH Cardiovascular Medicine fellow who is now a cardiologist at Kaiser Permanente San Francisco Medical Center. “To see that a virtual care team could help improve guideline-concordant care across three diverse system hospitals and do so in a manner that was both safe and did not prolong hospitalization was a very encouraging finding.”

Using this project as a foundation, the authors are looking scale up the study to see if they can reproduce with different variables like hospital type, geography, and population.

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