VITAL-HF pilot study, led by Dr. Marc Samsky of Yale University and Renee Leverty of Duke Clinical Research Institute, published results in the Journal of Clinical Medicine on a new approach to guideline-directed medical therapy (GDMT) to address the challenge of low GDMT adoption.
The low-adoption of Guideline-Directed Medical Therapy (GDMT) in heart failure patients has been well documented and can stem from various factors, including clinical inertia, challenges related to frequent clinical visits, and patient-specific considerations. Overcoming this underutilization is critical, given the well-established benefits of GDMT. The American College of Cardiology and American Heart Association have pinpointed the need for a deeper understanding of systematic approaches to managing Heart Failure with Reduced Ejection Fraction (HFrEF), particularly in the initiation and optimization of GDMT.
This study included patients with symptomatic HFrEF and employed a digital health tool, Story Health, that leveraged technology and virtual health coaches to drive patients to target GDMT. GDMT titrations were completed entirely remotely, eliminating the need for additional clinic visits. Each of the 12 participants were assigned a health coach, who assisted patients with medication education, pharmacy access, and lab access through text messages and phone calls. Additionally, participants received a blood pressure cuff and engaged in regular symptom surveys from home. The collected data were seamlessly transmitted to the Story Health platform, triggering automated alerts based on vital signs and laboratory data. The median follow up for these patients was 150 days.
The results showed effective up-titrations. The study saw active GDMT adjustments, including 10 GDMT initiations, 52 up-titrations, and 13 down-titrations. Implementing Story Health presents a more effective and efficient way to manage large patient populations.
Patients specifically expressed comfort in the knowledge that a team, including their health coach and doctor, was regularly reviewing their data, alleviating concerns about uncertainty in daily living. This added a sense of security and actually empowered patients to better understand the decision-making process related to GDMT medication changes and take a part in their own care. The study showcased that remote titration of GDMT is not only feasible but also a patient-centered approach to care.
This study demonstrated successful utilization of Story Health to enhance the management of heart failure and remove obstacles causing low target GDMT medication adoption by:
“With Story Health, we're already able to remove barriers that cause under-prescription and utilization of GDMT medications. This approach enables individualized care, ensuring sustained patient engagement for enduring results in their healthcare journey”, said Dr. Marc Samksy. “ This approach shows the potential to expand access to GDMT care by facilitating a fully remote titration approach.”
The complete study can be viewed online.
