Abstract
Background
There are limited data regarding the management of guideline-directed medical therapy
(GDMT) for heart failure with reduced ejection fraction (HFrEF) with virtual visits
in comparison with in-office visits. We sought to compare the changes in GDMT (angiotensin-converting
enzyme inhibitors, angiotensin II receptor blockers, angiotensin receptor neprilysin
inhibitors, mineralocorticoid receptor antagonists, and sodium glucose cotransporter-2
inhibitors) and loop diuretics across visit types.
Methods and Results
This study included 13,481 outpatient visits performed for 5439 unique patients with
HFrEF between March 16, 2020, and March 15, 2021. The rates of initiation and discontinuation
of GDMT were documented, and multivariable logistic regression was performed to test
associations with outcomes between modes of visit. The rates of medication initiation
were higher in office (11.7%) compared with video (9.6%) or telephone (7.2%) visits.
In multivariable adjusted analysis, the initiation of at least 1 GDMT class was similar
between in-office visits and video visits (adjusted odds ratio [OR] 0.97, 95% confidence
interval [CI] 0.82–1.14, P = .703). Telephone visits were associated with less frequent initiation of at least
1 class of GDMT in comparison with in-office visits (adjusted OR 0.64, 95% CI 0.55–0.75;
P < .001) and video visits (adjusted OR 0.67, 95% CI 0.55–0.81, P < .001). Despite similar rates of baseline loop diuretic use, patients seen with
both video visits (adjusted OR 0.70, 95% CI 0.52–0.94, P = .018) and telephone visits (adjusted OR 0.64, 95% CI 0.49-0.83, P < .001) were less likely to have a loop diuretic initiated when compared with in-office
visits.
Conclusions
The initiation of GDMT for HFrEF was similar between in-office and video visits and
lower with telephone visits, whereas the initiation of a loop diuretic was less frequent
in both types of virtual visits. These data suggest that video streaming capabilities
should be encouraged for virtual visits.
Key Words
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References
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Article info
Publication history
Published online: March 19, 2022
Accepted:
February 27,
2022
Received in revised form:
February 23,
2022
Received:
December 11,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
