A Pilot Program to Facilitate Guideline-Directed Medical Therapy Using Home Monitoring and Nurse Practitioner-Led Telephone Support for Patients With Heart Failure With Reduced Ejection Fraction

McLachlan, A.; Aldridge, C.; Morgan, M.; Gabriel, R.; Lund, M.; Malez, V.

Background: Heart failure with reduced ejection fraction (HFrEF) is associated with poor outcomes. While several medications are beneficial, achieving optimal Guideline-directed medical therapy is challenging. COVID-19 offered an opportunity to explore new ways of delivering care. Method: Fifty consecutive patients were identified following hospital discharge and taught to identify fluid congestion and monitor their vital signs using BP monitors & electronic scales, with nurse practitioner (NP)-led telephone support. Up-titration was facilitated by e-prescriptions and e-labforms. Quantitative data was collected, and a patient experience telephone interview was performed. Medication changes were notified to primary care in real time using an electronic template. Results: The majority (76%) of the cohort (mean age, 59 yrs;male, 76%;Māori or Pacific, 58%) had a new diagnosis of HFrEF, with 90% having an ejection fraction <30%. During the trial there were 216 contacts, 129 (60%) by telephone, which eliminated the need for travelling, (time saved, 2.12 hours/patient), less petrol costs ($58.17 per patient), less traffic pollution (607 Kg of CO2) and less time off work for patient or whanau. Most (75%) received first contact within 2 weeks of enrolment and 75% were optimally up titrated within 2 months. Statistically significant improvements in systolic blood pressure (124 mmHg down to 116 mmHg);pulse (78 bpm to 70 bpm) and B-type natriuretic peptide (BNP) (292 ng/L to 65 ng/L) were identified. Conclusion: Patients found the process acceptable and experienced faster up-titration with less need for clinic review with safety and up-titration rates comparable with most real-world clinical reports.