DASH-HF Study: A Pragmatic Quality Improvement Randomized Implementation Trial for Patients With Heart Failure With Reduced Ejection Fraction
Rattachement africain : us, ca. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
BACKGROUND: Heart failure is a prevailing diagnosis of hospitalization and readmission within 6 months, and nearly a quarter of these patients die within a year. Guideline-directed medication therapies reduce risk of mortality by 73% over 2 years; however, the implementation of these therapies to their target dose in clinical practice continues to be challenging. In 2020, the Veterans Affairs (VA) Health Care System developed a HF dashboard to monitor and improve outpatient HF management. The DASH-HF (Dashboard Activated Services and Telehealth for Heart Failure) study is a randomized, pragmatic clinical trial to evaluate proactive dashboard-directed telehealth clinics to improve the use and dosing of guideline-directed medication therapy for patients with heart failure with reduced ejection fraction not on optimal guideline-directed medication therapy within the VA. METHODS: Three hundred veterans with heart failure with reduced ejection fraction met inclusion criteria with an optimization potential score (OPS) of 5 or less out of 10, representing nonoptimal guideline-directed medication therapy. The primary outcome was a composite score of guideline-directed medical therapy, the OPS, 6 months after the end of the intervention. Secondary outcomes included active prescriptions for each individual guideline-directed medical therapy class, HF-related hospitalizations, deaths, and clinician time per patient during the intervention clinics. RESULTS: There was no significant difference between the intervention arm and usual care group in the primary outcome (OPS, 2.9; SD=2.1 versus OPS, 2.6, SD=2.1); adjusted mean difference 0.3 (95% CI, -0.1 to 0.7) or in the prespecified secondary outcomes for hospitalization and all-cause mortality for the intervention of proactive dashboard-based clinics. CONCLUSIONS: A dashboard-based clinic intervention did not improve the OPS or secondary outcomes of hospitalization and all-cause mortality. There remains a larger opportunity to better target patients and provide more intensive follow-up to further evaluate the utility of proactive dashboard-based clinics for HF management and quality improvement. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT05001165.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- DASH-HF Study: A Pragmatic Quality Improvement Randomized Implementation Trial for Patients With Heart Failure With Reduced Ejection Fraction
- Date Crossref
- 01/09/2023
- Éditeur
- Ovid Technologies (Wolters Kluwer Health)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of California Department of Medicine (A.V. pays non établi dans la noticeUniversité ou école supérieure
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VA Greater Los Angeles Healthcare System pays non établi dans la noticeÉtablissement de santé
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Western University Department of Pharmacy Practice and Administration pays non établi dans la noticeUniversité ou école supérieure
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Institute of Health Services and Policy Research pays non établi dans la noticeStructure de recherche
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Institute for Clinical Evaluative Sciences pays non établi dans la noticeOrganisation à but non lucratif
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Western University of Health Sciences pays non établi dans la noticeUniversité ou école supérieure
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University of Pittsburgh Department of Medicine pays non établi dans la noticeUniversité ou école supérieure
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Division of Cardiology pays non établi dans la noticeInstitution
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Department of Pharmacy pays non établi dans la noticeInstitution
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University of Toronto Institute of Health Policy pays non établi dans la noticeUniversité ou école supérieure
Department of Medicine (A.V. — University of California, VA Greater Los Angeles Healthcare System et Department of Pharmacy Practice and Administration — Western University, avec 7 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.