{"doi":"10.1002/ejhf.2163","title":"Virtual optimization of guideline‐directed medical therapy in hospitalized patients with heart failure with reduced ejection fraction: the IMPLEMENT‐HF pilot study","abstract":"AIMS: Implementation of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) remains incomplete. Non-cardiovascular hospitalization may present opportunities for GDMT optimization. We assessed the efficacy and durability of a virtual, multidisciplinary 'GDMT Team' on medical therapy prescription for HFrEF. METHODS AND RESULTS: Consecutive hospitalizations in patients with HFrEF (ejection fraction ≤40%) were prospectively identified from 3 February to 1 March 2020 (usual care group) and 2 March to 28 August 2020 (intervention group). Patients with critical illness, de novo heart failure, and systolic blood pressure <90 mmHg in the preceeding 24 hs prior to enrollment were excluded. In the intervention group, a pharmacist-physician GDMT Team provided optimization suggestions to treating teams based on an evidence-based algorithm. The primary outcome was a GDMT optimization score, the sum of positive (+1 for new initiations or up-titrations) and negative therapeutic changes (-1 for discontinuations or down-titrations) at hospital discharge. Serious in-hospital safety events were assessed. Among 278 consecutive encounters with HFrEF, 118 met eligibility criteria; 29 (25%) received usual care and 89 (75%) received the GDMT Team intervention. Among usual care encounters, there were no changes in GDMT prescription during hospitalization. In the intervention group, β-blocker (72% to 88%; P = 0.01), angiotensin receptor-neprilysin inhibitor (6% to 17%; P = 0.03), mineralocorticoid receptor antagonist (16% to 29%; P = 0.05), and triple therapy (9% to 26%; P < 0.01) prescriptions increased during hospitalization. After adjustment for clinically relevant covariates, the GDMT Team was associated with an increase in GDMT optimization score (+0.58; 95% confidence interval +0.09 to +1.07; P = 0.02). There were no serious in-hospital adverse events. CONCLUSIONS: Non-cardiovascular hospitalizations are a potentially safe and effective setting for GDMT optimization. A virtual GDMT Team was associated with improved heart failure therapeutic optimization. This implementation strategy warrants testing in a prospective randomized controlled trial.","journal":"European Journal of Heart Failure","year":2021,"id":152413,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":75,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9511,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":231419,"name":"Anubodh S. Varshney","orcid":"0000-0002-9697-8948","position":1,"is_corresponding":false},{"id":647494,"name":"Mahan Nekoui","orcid":"0000-0001-7466-4801","position":2,"is_corresponding":false},{"id":234174,"name":"Alea Moscone","orcid":null,"position":3,"is_corresponding":false},{"id":899,"name":"Jonathan W. Cunningham","orcid":"0000-0003-4481-7867","position":4,"is_corresponding":false},{"id":260469,"name":"Karola Jering","orcid":"0000-0002-5243-1959","position":5,"is_corresponding":false},{"id":497379,"name":"Parth Patel","orcid":"0000-0003-3561-796X","position":6,"is_corresponding":false},{"id":536313,"name":"Lauren Sinnenberg","orcid":"0000-0003-2443-2927","position":7,"is_corresponding":false},{"id":648717,"name":"Thomas D. Bernier","orcid":null,"position":8,"is_corresponding":false},{"id":647495,"name":"Leo F. Buckley","orcid":"0000-0003-1570-1486","position":9,"is_corresponding":false},{"id":647496,"name":"Bryan M. 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Snyder","orcid":"0009-0005-1821-3375","position":19,"is_corresponding":false},{"id":647500,"name":"Clara Ting","orcid":"0000-0003-0376-6717","position":20,"is_corresponding":false},{"id":231418,"name":"Erin E. McElrath","orcid":"0000-0001-5290-6742","position":21,"is_corresponding":false},{"id":647501,"name":"Mary G. Amato","orcid":"0000-0002-0247-9049","position":22,"is_corresponding":false},{"id":648723,"name":"Maryam Alobaidly","orcid":null,"position":23,"is_corresponding":false},{"id":648724,"name":"Catherine Ulbricht","orcid":null,"position":24,"is_corresponding":false},{"id":270945,"name":"Niteesh K. Choudhry","orcid":"0000-0001-7719-2248","position":25,"is_corresponding":false},{"id":231420,"name":"Dale Adler","orcid":"0000-0002-0831-4413","position":26,"is_corresponding":false},{"id":61406,"name":"Muthiah Vaduganathan","orcid":"0000-0003-0885-1953","position":27,"is_corresponding":false},{"id":231417,"name":"Ankeet S. Bhatt","orcid":"0000-0002-6449-4535","position":0,"is_corresponding":true}],"reference_count":29,"raw_metadata":null,"created_at":"2026-07-18T23:43:34.972031Z","pmid":"33768599","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}