Abstract 15142: Consistent Improvement in Utilization of Guideline Directed Medical Therapy Race for Traditionally Underserved Populations Using a Remote Intervention

Abstract

Background: Heart failure (HF) disproportionately affects populations traditionally underserved in medicine. Remote healthcare delivery expands the reach of health care systems and providers, however some fear new models may pose challenges to equitable health care delivery. By building a remote HF clinic we aimed to increase equitable access to guideline-directed medical therapy (GDMT) optimization for HF. Methods: Patients with HF and a left ventricular ejection fraction < 40% were identified by health record screening. Patients’ cardiologist was approached to participate in the remote intervention (RI) program, and those who declined their patient’s involvement served as a reference ‘usual care’ (UC) group. HF medications in the RI group were adjusted by pharmacists and patient navigators according to a GDMT titration algorithm. We examined differences in the efficacy of the intervention by race and separately by area deprivation index (ADI) - a validated method of stratifying neighborhood-level health determinants (higher scores indicate fewer resources). Results: Of 1131 eligible patients, 196 completed the 3-month follow-up in the RI group. The RI group included 16.8% Black individuals, 59.2% of patients in the low (1-5) ADI category and 29.6% in the high (6-10) ADI category. The UC group included 831 patients: 9.9% Black individuals, 54.0% in the low ADI category and 25.6% in the high ADI category. When compared to Black patients in UC, Black patients who participated in the RI program saw more medication titrations and rates of reaching target dosage for both ACE/ARB/ARNI & beta-blockers (BB). When compared across ADI, the RI group had increased rates of ACE/ARB/ARNI & BB titration and target dose achieved in the low and high ADI categories compared the UC group (Figure 1). Conclusion: A remote HF program was able to improve utilization of GDMT regardless of race and ADI. This care model may improve access to HF care for traditionally underserved populations.