European Journal of Heart Failure | 2021
Optimizing evidence‐based heart failure medication: every contact counts
Abstract
During 2020, the delivery of traditional health care across Europe had to adapt, in response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Virtual consultations became integrated into the daily fabric of heart failure (HF) management, changing patients’ and health care professionals’ attitudes towards remote management. This paradigm shift towards an increased use of telemonitoring or remote monitoring was supported by expert consensus papers and results from clinical trials, such as the TIM-HF2 trial.1,2 This trial enrolled 1571 symptomatic patients with HF reduced ejection fraction (HFrEF) from hospitals and cardiology settings, who were randomly assigned to receive 24 h access to physician-led management and support, facilitated through ‘predefined algorithms and biomarker values’ or usual care. The study concluded that a structured remote patient management system reduced the percentage of days lost due to unplanned cardiovascular hospital admissions and all-cause mortality.3 The innovative prospective, pre-post pilot interventional study by Bhatt et al.,4 represented by the acronym IMPLEMENT-HF, recruited 118 hospitalized patients to either usual care (n = 29) or a guideline-directed medical therapy (GDMT) Team intervention (n = 89), according to the month the patient was admitted. Criteria for exclusion were de novo HFrEF, recent acute coronary syndrome or stroke, recent cardiac surgery, systolic blood pressure <90 mmHg within the past 24 h, or coronavirus 2. The intervention involved cardiology-trained pharmacists and physicians providing remote recommendations to optimize each patient’s pharmaceutical HF treatment according to a guideline-derived algorithm and clinical parameters. These recommendations were provided to and actioned by the non-specialist physician, caring for the patient admitted onto a non-cardiac ward.