A Home-Based Phone Intervention Improved Uptake of Recommended Medical Treatment for Heart Failure Among Patients in Navajo Nation

A new study finds that a home-based phone intervention improved uptake of guideline-directed medical therapy (GDMT) for Navajo patients with heart failure with reduced ejection fraction, or the inability to pump enough blood into the body.

This is an important finding because GDMT is the recommended treatment protocol for people with heart failure. However, research shows GDMT uptake to be sub-optimal and a major cause of poor outcomes among patients.

Among Native American people, access to heart care is limited due to:

• Time constraints
• Lack of transportation
• Rural location
• Clinician unavailability
• Discomfort with newer drugs for heart failure

Researchers implemented a home-based phone GDMT with telemonitoring among 103 patients with heart failure receiving care at two Indian Health Service clinics in rural Navajo to determine if this would increase GDMT uptake within 30 days.

At the beginning of this randomized clinical trial, patients (18 years or older) were assigned to receive either the phone-based GDMT (telehealth) or the usual GDMT care. Every 30 days, patients in the usual GDMT care were transferred to the telehealth group at 5 different times until all patients were receiving telehealth care.

Usual GDMT care included in-person visits with a clinician. In the telehealth arm, patients were:

• Given a home blood pressure cuff and trained on how to use it.
• Contacted by the telehealth team to discuss prescribed GDMT medications.
• Instructed to come in-person to the clinic for blood work 1 to 2 weeks after starting a new medication.

This was followed with a check-in phone call after 1 week to assess drug tolerability and to collect home blood pressure and heart rate recordings. Ongoing calls occurred every 1 to 2 weeks for continued medication increase until patients were taking the maximum tolerated doses of GDMT.

Compared to the usual care, there was a higher rate of GDMT medications filled from the pharmacy at 30 days in the telehealth arm (66.2% vs. 13.1%). The phone-based intervention with telemonitoring increased GDMT uptake in patients with heart failure and reduced hospitalizations more than the usual care.

The GDMT telehealth strategy differs from traditional telehealth care because it does not rely on clinicians’ or specialists’ availability as telehealth calls can occur at any time. It also prioritizes patients who are not receiving adequate care and allows for timely treatment modification. The researchers suggest that this low-cost strategy could be expanded to other rural settings, especially where physical access to care is limited, emphasizing that GDMT interventions must be community-designed and tailored to fit local contexts.

Citation
Eberly, L. A., Tennison, A., Mays, D., Hsu, C-Y., Yang, C-T., Benally, E., Beyuka, H., Feliciano, B., Norman, C.J., Brueckner, M.Y., Bowannie, C., Schwartz, D.R., Lindsey, E., Friedman, S., Ketner, E., Detsoi-Smiley, P., Shyr, Y., Shin, S., & Merino, M. (2024). Telephone-based guideline-directed medical therapy optimization in Navajo Nation: The Hózhó randomized clinical trial. JAMA Internal Medicine, 184(6), 681-690. doi:10.1001/jamainternmed.2024.1523

Page published Nov. 21, 2024