Playing it close to the VEST and the clinical guidelines: Clinical guideline compliance in HFrEF patients—Role of WCD

Abstract

Guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF) has been challenging to achieve universally. Healthcare providers who seek to achieve optimal medical therapy frequently consider either a wearable cardioverter defibrillator (WCD) or an implantable cardioverter defibrillator (ICD) as indicated. The dynamic process of communication and physician recommendations marks a setting to study the relative interdependence of medical therapies and best practice. The purpose of this study was to examine the long-term impact of the WCD on GDMT. We hypothesized the WCD serves as a "gateway" therapy, likely impacting other optimal strategies such that successful use of WCD improves GDMT adherence. Electronic medical records (EPIC) were manually reviewed to extract data elements in this observational study of 1289 HFrEF patients from 2013-2015. Data included demographics, comorbidities, and use of GDMT including an ICD use in persistently low ejection fraction (≤36%) patients after 90 days. WCD use was significantly associated with prescribing adherence to GDMT, χ2 (1, N=981)=33.36, P<0.001. Further, WCD use was significantly associated with recommendations for follow-up echocardiographic study, χ2 (1, N=865)=66.94, P<0.001 and use of primary prevention ICD, χ2 (1, N=1093)=19.00, P<0.001. This study demonstrates the use of the WCD correlates with improved clinician use of GDMT, follow-up echocardiographic studies, and appropriate use of primary prevention ICD. Thus, the potential benefits of the WCD and its care processes may extend beyond prevention of sudden cardiac death to enhanced optimization of GDMT.