Underutilization of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) is a major cause of poor outcomes. For many American Indian patients receiving care through the Indian Health Service (IHS), access to care, especially cardiology care, is limited.

As part of an Indian Health Service (IHS) Innovations Award, supported by the IHS Office of Quality, we designed a telehealth heart failure care delivery model to improve the quality of heart failure (HFrEF) care in the Gallup Service Unit of the Indian Health Service (Gallup Indian Medical Center and Tohatchi Health Center). This model was designed with stakeholder input to address identified barriers to accessing quality care among our patient population, and improve rates of guideline directed medical therapy (GDMT) for HFrEF.

This telehealth model is a phone-based GDMT optimization program with telemonitoring utilizing a home blood pressure cuff. Details of this model, and associated protocols utilized for GDMT optimization, are summarized on this site. In short, patients received a home blood pressure cuff, and all medication initiation and titration is performed remotely over the phone with established protocols, with the goal to get patients on 4-pillar GDMT as quickly as possible.

We performed a pragmatic, randomized, stepped-wedge comparative effectiveness trial. Patients with HFrEF receiving care at 2 IHS facilities in Navajo Nation were randomized to the telehealth care model or usual care in a stepped-wedge fashion, with 5 time points (30-day intervals) until all patients had crossed over into the intervention. The primary outcome was an increase in the number of GDMT classes filled from pharmacy at 30-days post randomization. Secondary outcomes include increase in rates of each GDMT class and safety outcomes.

**Hózhó- is a Diné (Navajo) concept for beauty, balance, and wellness.

*This study was approved by the NNHRRB (NNR-23.470) *