How to tackle therapeutic inertia in heart failure with reduced ejection fraction. A scientific statement of the Heart Failure Association of the ESC

Abstract

Guideline‐directed medical therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF) reduces morbidity and mortality, but its implementation is often poor in daily clinical practice. Barriers to implementation include clinical and organizational factors that might contribute to clinical inertia, i.e. avoidance/delay of recommended treatment initiation/optimization. The spectrum of strategies that might be applied to foster GDMT implementation is wide, and involves the organizational set‐up of heart failure care pathways, tailored drug initiation/optimization strategies increasing the chance of successful implementation, digital tools/telehealth interventions, educational activities and strategies targeting patient/physician awareness, and use of quality registries. This scientific statement by the Heart Failure Association of the ESC provides an overview of the current state of GDMT implementation in HFrEF, clinical and organizational barriers to implementation, and aims at suggesting a comprehensive framework on how to overcome clinical inertia and ultimately improve implementation of GDMT in HFrEF based on up‐to‐date evidence.

What's new in heart failure? May–June 2024

“…12,13 A scientific statement from the Heart Failure Association of the European Society of Cardiology identifies therapeutic inertia as a critical issue in managing patients with HFrEF. 14 Therapeutic inertia refers to the delay or avoidance in initiating or optimizing treatment, which is crucial for reducing morbidity and mortality in patients with HFrEF. Despite the proven benefits of GDMT, its implementation remains suboptimal due to various clinical and organizational barriers.…”

“…By addressing both clinical and organizational barriers through personalized care, structured follow-up, educational interventions, and leveraging new technologies, healthcare providers can significantly improve the implementation of GDMT, ultimately enhancing patient outcomes in HFrEF. 14…”