Dashboard-Directed Intervention to Improve Guideline-Directed Heart Failure Therapy for Veterans

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BACKGROUND: Significant gaps in guideline-directed medical therapy (GDMT) persist in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Although population health dashboards can identify these gaps, sustainable workflows integrating them into routine practice remain largely underutilized. OBJECTIVES: This study aimed to evaluate the implementation and outcomes of a dashboard-based intervention in a novel clinical-educational hybrid model aimed to improve GDMT use. METHODS: From July 2024 to June 2025, a weekly, half-day HF Dashboard Population Health Clinic was implemented at a single Veterans Affairs center. A supervised team of cardiology fellows and nurse practitioners performed medical record reviews of patients with gaps in GDMT identified on the Veterans Affairs HF Dashboard, with a focus on underutilization of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in HFrEF patients. Clinicians executed targeted telehealth interventions, initiated therapies, and coordinated follow-up. Outcomes were measured via an optimization score for each GDMT component (0 = none, 1 = low dose, 2 = target dose). RESULTS: Over 1 year, 163 patients received the Dashboard Clinic intervention; 128 (78.5%) had HFrEF and 150 (92.0%) were not receiving SGLT2i therapy. In 79 patients (48.5%), GDMT was initiated via telephone or recommended for initiation. In patients who qualified for GDMT optimization (N = 107), the composite optimization score increased from 2.10 (SD = 1.88) before intervention to 2.81 (SD = 2.17) after intervention (P = 0.018), and the OS of SGLT2i therapy increased from 0.40 (SD = 0.80) to 0.74 (SD = 0.97) (P = 0.013). CONCLUSIONS: The Dashboard Clinic is a viable and potentially effective intervention for GDMT optimization, providing a scalable blueprint for dashboard-directed care.

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