{"id":"808c34c2abdf","type":"article","url":"https://hartvaat.nl/2024/06/04/drive-remote-management-verbetert-richtlijnmedicatie-bij-hartfalen/","title":"DRIVE: remote management verbetert richtlijnmedicatie bij hartfalen","title_en":"Randomized Evaluation of a Remote Management Program to Improve Guideline-Directed Medical Therapy: The DRIVE Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.124.069494","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.124.069494","authors":["Alexander J Blood","Lee-Shing Chang","Shahzad Hassan","Jacqueline Chasse","Gretchen Stern","Daniel Gabovitch","David Zelle","Caitlin Colling","Samuel J Aronson","Christian Figueroa","Emma Collins","Ryan Ruggiero","Emily Zacherle","Joshua Noone","Carey Robar","Jorge Plutzky","Thomas A Gaziano","Christopher P Cannon","Deborah J Wexler","Benjamin M Scirica"],"significance":7,"published":"2024-06-04","source_date":"2024-06-04","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"The DRIVE trial showed that a remote management program significantly improves guideline-directed medication use and dosing in heart failure patients, demonstrating that technology-assisted remote optimization can bridge the gap between guidelines and practice.","created":"2026-07-03T10:30:58Z","updated":"2026-07-03T13:30:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De DRIVE-trial toonde dat een remote managementprogramma het gebruik en de dosering van richtlijnmedicatie bij hartfalen significant verbeterde. Digitale monitoring met proactieve medicatie-aanpassing is effectief.","abstract_original":"BACKGROUND: Several SGLT2i (sodium-glucose transport protein 2 inhibitors) and GLP1-RA (glucagon-like peptide-1 receptor agonists) reduce cardiovascular events and improve kidney outcomes in patients with type 2 diabetes; however, utilization remains low despite guideline recommendations. METHODS: A randomized, remote implementation trial in the Mass General Brigham network enrolled patients with type 2 diabetes with increased cardiovascular or kidney risk. Patients eligible for, but not prescribed, SGLT2i or GLP1-RA were randomly assigned to simultaneous virtual patient education with concurrent prescription of SGLT2i or GLP1-RA (ie, Simultaneous) or 2 months of virtual education followed by medication prescription (ie, Education-First) delivered by a multidisciplinary team driven by nonlicensed navigators and clinical pharmacists who prescribed SGLT2i or GLP1-RA using a standardized treatment algorithm. The primary outcome was the proportion of patients with prescriptions for either SGLT2i or GLP1-RA by 6 months. RESULTS: Between March 2021 and December 2022, 200 patients were randomized. The mean age was 66.5 years; 36.5% were female, and 22.0% were non-White. Overall, 30.0% had cardiovascular disease, 5.0% had cerebrovascular disease, and 1.5% had both. Mean estimated glomerular filtration rate was 77.9 mL/(min‧1.73 m2), and mean urine/albumin creatinine ratio was 88.6 mg/g. After 2 months, 69 of 200 (34.5%) patients received a new prescription for either SGLT2i or GLP1-RA: 53.4% of patients in the Simultaneous arm and 8.3% of patients in the Education-First arm (P<0.001). After 6 months, 128 of 200 (64.0%) received a new prescription: 69.8% of patients in the Simultaneous arm and 56.0% of patients in Education-First (P<0.001). Patient self-report of taking SGLT2i or GLP1-RA within 6 months of trial entry was similarly greater in the Simultaneous versus Education-First arm (69 of 116 [59.5%] versus 37 of 84 [44.0%]; P<0.001) Median time to first prescription was 24 (interquartile range [IQR], 13-50) versus 85 days (IQR, 65-106), respectively (P<0.001). CONCLUSIONS: In this randomized trial, a remote, team-based program identifies patients with type 2 diabetes and high cardiovascular or kidney risk, provides virtual education, prescribes SGLT2i or GLP1-RA, and improves guideline-directed medical therapy. These findings support greater utilization of virtual team-based approaches to optimize chronic disease management. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06046560."}