Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jun 26, 2025; 17(6): 107102
Published online Jun 26, 2025. doi: 10.4330/wjc.v17.i6.107102
Impact of optimal medical therapy in heart failure certification for hospitalists on guideline-directed medical therapy utilization
Farhan Ishaq, Duc T Nguyen, Edward A Graviss, Ebun Ebunlomo, Arvind Bhimaraj, Nadia Fida
Farhan Ishaq, Ebun Ebunlomo, Arvind Bhimaraj, Nadia Fida, Department of Cardiology, Houston Methodist Hospital, Houston, TX 77030, United States
Duc T Nguyen, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, United States
Edward A Graviss, Division of Medicine, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Institute for Academic Medicine, Houston, TX 77030, United States
Nadia Fida, Department of Cardiology, Houston Methodist Baytown Hospital, Baytown, TX 77521, United States
Author contributions: Ishaq F, Ebunlomo E, Bhimaraj A, and Fida N designed the study; Ishaq F and Fida N performed the research and wrote the manuscript; Nguyen DT and Graviss EA analyzed the data; Nguyen DT, Graviss EA, Ebunlomo E, and Bhimaraj A revised the manuscript; all authors have read and approved the final manuscript.
Supported by Houston Methodist DeBakey Heart and Vascular Center Grant.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board (No. PRO00035436).
Clinical trial registration statement: This study is registered at Houston Methodist Hospital’s institutional registry.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: Additional data available on request, consent was not obtained but the presented data are anonymized, and risk of identification is low.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nadia Fida, MD, Assistant Professor, Director, Department of Cardiology, Houston Methodist Baytown Hospital, 4301 Garth Road, Baytown, TX 77521, United States. nfida@houstonmethodist.org
Received: March 17, 2025
Revised: April 6, 2025
Accepted: May 27, 2025
Published online: June 26, 2025
Processing time: 95 Days and 19.3 Hours
Abstract
BACKGROUND

Significant gaps in guideline-directed medical therapy (GDMT) for heart failure (HF) stem from shortages of cardiologists and advanced HF providers, as well as a lack of optimal HF management knowledge among hospitalists. This study compared the impact of optimal medical therapy in HF (OMT-HF) certification on GDMT implementation and patient outcomes between an intervention group (IG) of hospitalists and a standard-of-care comparison group (SOC-CG).

AIM

To evaluate if OMT-HF has a difference in GDMT and patients in outcomes between IG and SOC-CG.

METHODS

This study was implemented from November 2022 to May 2023. Hospitalized cardiology patients with HF and left ventricular ejection fraction ≤ 40% were randomized to IG or SOC-CG. Exclusion criteria included patients in cardiogenic shock, unable to consent, or at high risk. Follow-up was at 30 days post-discharge. Differences between groups were analyzed using Fisher’s exact test for categorical variables and Wilcoxon rank-sum or unpaired t-test for continuous variables. Changes in Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores were evaluated using a paired t-test.

RESULTS

IG patients had lower readmission rates [(9 (42.85%) vs 11 (17.46%), P = 0.03] and a decreased trend in mortality 30-day post discharge. IG patients also showed greater mean improvements in total (-27.03 ± 24.59 vs -5.85 ± 23.52, P < 0.001), physical (-13.8 ± 12.3 vs -2.71 ± 11.16, P < 0.001) and emotional (-4.76 ± 8.10 vs -1.42 ± 5.98) dimensions on the MLWHFQ compared to SOC-CG, however, change in emotional dimension did not reach statistical significance.

CONCLUSION

Hospitalist OMT-HF certification may lead to better 30-day outcomes in hospitalized HF patients including quality of life, mortality and readmission rates. Larger prospective studies are warranted to validate these findings.

Keywords: Heart failure education optimization; Guideline directed medical therapy; Heart failure; Quality of Life; Optimal medical therapy in heart failure

Core Tip: In patients with heart failure (HF) with reduced ejection fraction who are admitted to the hospital, seeing an optimal medical therapy in HF (OMT-HF) certified hospitalist can lead to improved guideline directed medical therapy scores, improved quality of life scores on the Milwaukee Living with Heart Failure Questionnaire 30 days post-discharge and lower 30-day readmission rates compared to those who did not see an OMT-HF certified hospitalist.