Abstract 10551: Management of Guideline-Directed Medical Therapy for Heart Failure in Office, Video and Telephone Outpatient Visits

Abstract

Background: There are limited data about management of guideline-directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF) with telehealth visits versus office visits. We sought to compare differences in the use of GDMT and loop diuretics between office, video, and telephone visits. Methods: We included 13,481 outpatient visits performed for 5,439 unique patients with HFrEF between March 16, 2020 and March 15, 2021. Multivariable logistic regression analysis was used to test differences between visit modes. Results: Overall, at least one GDMT class was started in 11.7% of office visits, 9.6% of video visits and 7.2% of telephone visits. Meanwhile, loop diuretics were initiated in 4.4% of office visits, 2.5% of video visits and 2.6% of telephone visits. After adjustment to baseline use of GDMT and loop diuretics, the rates of starting at least 1 GDMT class were similar between video and office visits (adjOR 0.95; 95% CI 0.82-1.12; p=0.558). There were no differences between video and office visits in discontinuing at least 1 GDMT class (adjOR 0.86; 0.71-1.04; p=0.119). Telephone visits were associated with less frequent initiation of at least 1 GDMT class compared with office visits (adjOR 0.77; 0.71-0.83; p<0.001), and video visits (adjOR 0.61; 0.51-0.74; p<0.001). Discontinuing at least 1 GDMT class during telephone visits was also less frequent than office visits (adjOR 0.91; 0.84-0.99; p=0.041), albeit similar to video visits. Compared with office visits, adding loop diuretics was less frequent with both video visits (adjOR 0.62; 0.47-0.83; p=0.001), and telephone visits (adjOR 0.62; 0.48-0.79; p<0.001) ( Figure ). Conclusion: The initiation of GDMT for HFrEF was similar between office and video visits, but lower with telephone visits, whereas the initiation of loop diuretics was lower with both video and telephone visits compared with office visits. These data can be useful when planning to augment GDMT in HFrEF using telehealth visits.