A Summative Evaluation of a Remote Medication Titration Program for Patients with Heart Failure

Abstract

Purpose: This DNP program evaluation aimed to provide a quantitative retrospective analysis of the outcomes and impacts of a remote heart failure (HF) guideline-directed medical therapy (GDMT) titration program implemented at the Mayo Clinic in Arizona.Background: Heart failure (HF), whether chronic or progressive, increases mortality, morbidity, healthcare consumption, and costs. Despite significant diagnostic and therapeutic advancements, long-term heart failure management remains a challenge. Based on available research, it is possible to conclude that remote titration of guideline-directed medical therapy for heart failure leads to higher usage and optimization of said medications. Until now, a thorough evaluation of the remote titration program for heart failure medical therapies has not been conducted at Mayo Clinic in Arizona. The primary objective of this summative program evaluation was to determine the effectiveness of the remote titration program in accomplishing its goals. Methods: A retrospective data analysis of the remote titration program was conducted between March and May of 2023. A report was generated within the electronic health records (EHR) identifying 605 qualifying patients. A two-ladder approach was used to reach a sample size of 200 patients. The sample size was assessed to ascertain the proportion of participants who achieved their personalized target dose. Additionally, the study investigated whether the completed protocols were finalized within 180 days and, if not, the duration required to titrate the heart failure medications. Lastly, the evaluation identified perceived barriers to optimizing heart failure therapies. Results: Data analysis revealed that 30% of participants successfully attained their personalized targeted dosages. In this cohort, 90% of patients, reached their individualized target doses within 180 days, with a mean duration of 102.3 days in the total sample size. Hypotension emerged as the primary impediment to patients achieving target doses of their individualized protocols. Conclusions: The study showed evidence that the remote nurse-led and protocol-driven heart failure guideline-directed medical therapy titration effort was effective. This intervention increased the prescription of GDMTs while improving left ventricular ejection fraction and decreasing natriuretic peptide levels in patients. The evaluation results give empirical support for the program’s basic principles and assumptions.