Breaking the Status Quo in Heart Failure: Leveraging Remote Patient Monitoring to Effectively Put the Heart Failure Guidelines to Practice

Background Despite guideline directed medical therapy (GDMT) being recognized to improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF), optimization has been limited resulting in worse outcomes and exorbitant costs. Although remote patient monitoring (RPM) has proven to help improve patient care, implementation of RPM at scale leading to healthcare cost savings has not been demonstrated. Methods Patients from 11 states were enrolled from August 2021 to April 2023 in a virtual heart failure (HF) program offered by Cadence. Eligible patients were Medicare beneficiaries with a history of an ejection fraction (EF) <40%. A clinical team monitored patient daily vitals measured on a cellular enabled blood pressure (BP) cuff, heart rate monitor and weight scale. Clinical visits using technology enabled clinical protocols were also conducted on a regular basis to facilitate guideline directed clinical interventions including symptom, vital and medication optimization. Cost analysis used 5 years of de-identified healthcare claims data from an Accountable Care Organization (ACO) and calculated average monthly healthcare costs using the 4-month period of January-April for each year. We then used a Differences-in-Differences analysis to estimate the effect of Cadence on average monthly healthcare costs compared to ACO patients who were ordered for Cadence but did not enroll. Results Total of 367 patients (mean [SD]: age 74 [11] years; EF 45 [2] %; systolic BP (SBP) 131 [19] mmHg; n [%]: 122 women [33%]; 260 white (71%)) were followed for a median of 294 days. There was a significant decrease in patients’ BP (SBP -6.9, Diastolic BP -4.9 mmHg; p<0.001) and weight (−2.1 lbs; p=0.010) but not heart rate. Patients experienced significant increases in the use of sodium glucose co-transporter 2 inhibitors (92 [26%] to 165 [45%]; p<0.001) and mineralocorticoid receptor antagonists (120 [33%] to 144 [39%]; p=0.002) but not β-blockers or renin-angiotensin system antagonists. The percentage of patients on ≥50% target dose significantly increased for all pillars of GDMT. There was also a significant increase in the percentage of patients on all 4 pillars of GDMT at follow (84 [23%] vs. 26 [7%]; p<0.001). A total of 70 enrolled and 42 ordered but not enrolled HF patients were included in the ACO analysis. Compared to ordered but not enrolled patients, enrollment in Cadence resulted in a 52% (-$1,076.64 per HF patient per month) cost reduction, with the most significant reductions related to hospitalizations and hospital associated spending. Conclusions We present the first evidence to support the use of a remote patient intervention program that leverages RPM and technology supported clinical interventions to not only improve the use and dose of GDMT for HFrEF patients but also reduce total and hospital associated costs.