Improving implementation of evidence‐based therapies for heart failure

DeVore, Adam D.; Bosworth, Hayden B.; Granger, Bradi B.

doi:10.1002/clc.23845

Cited by 5 publications

(5 citation statements)

References 43 publications

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“…Taken together, the above results highlight important knowledge gaps regarding the management strategies for HFrEF recommended by current guidelines, and particularly quadruple therapy. Various factors can act as obstacles to the adoption of GDMT for HF including clinician knowledge gaps, lack of patient/caregiver awareness, patients in clinical trials not being representative of those in the real-world setting, high treatment costs, and a lack of evidence of the bene ts of implementation strategies [23]. Among these factors, clinician knowledge gaps are recognized as particularly important barriers to the implementation of GDMT in patients with HFrEF [23].…”

Section: Discussionmentioning

confidence: 99%

“…Various factors can act as obstacles to the adoption of GDMT for HF including clinician knowledge gaps, lack of patient/caregiver awareness, patients in clinical trials not being representative of those in the real-world setting, high treatment costs, and a lack of evidence of the bene ts of implementation strategies [23]. Among these factors, clinician knowledge gaps are recognized as particularly important barriers to the implementation of GDMT in patients with HFrEF [23]. Interventions such as guideline dissemination and education have been shown to improve adherence to cardiovascular disease guidelines [24].…”

Section: Discussionmentioning

confidence: 99%

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Knowledge and Practices regarding Guideline-directed Medical Therapy for Heart Failure with Reduced Ejection Fraction (HFrEF) among Physicians in Beijing, China: a Cross- sectional Study

Xie,

Wang,

Geng

et al. 2023

Preprint

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Background Heart failure with reduced ejection fraction (HFrEF) is an important cause of morbidity and mortality. This study aimed to evaluate the knowledge and practices of physicians in Beijing toward the use of guideline-directed medical therapy (GDMT) for HFrEF. Methods This cross-sectional study enrolled physicians at 13 districts of Beijing between November 2022 and December 2022. A self-administered questionnaire was designed that included demographic, knowledge and practice dimensions. Results The study included 290 physicians (females, 63.79%). The average knowledge score was 28.23 ± 9.03 (total score: 43), indicating a moderate level of knowledge. Knowledge gaps were identified in areas such as the use and dosing of angiotensin receptor-neprilysin inhibitors (ARNIs), beta-blockers, mineralocorticoid receptor antagonists (MRAs) and sodium-glucose cotransporter-2 (SGLT2) inhibitors. A higher knowledge score was associated with higher qualifications, specialization as a cardiologist, senior professional title and more than 5 years of work experience (all P < 0.05). Suboptimal practices were identified in the prescribing and dosing of ARNIs, beta-blockers, MRAs and SGLT2 inhibitors. Conclusion The physicians in Beijing had unsatisfactory knowledge and inadequate practices regarding GDMT for HFrEF. The findings may facilitate the design and implementation of training interventions to raise awareness about GDMT for HFrEF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Knowledge and Practices regarding Guideline-directed Medical Therapy for Heart Failure with Reduced Ejection Fraction (HFrEF) among Physicians in Beijing, China: a Cross- sectional Study

Xie,

Wang,

Geng

et al. 2023

Preprint

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“…Lifestyle modifications, such as salt restriction, weight management, and physical activity, are also important components of the chronic management of heart failure. These lifestyle modifications can improve symptoms, reduce hospitalization, and improve quality of life in patients with heart failure [89].…”

Section: Chronic Managementmentioning

confidence: 99%

Shaping the Future of Cardiac Wellness: Exploring Revolutionary Approaches in Disease Management and Prevention

Addissouky,

El Tantawy El Sayed,

Ali

et al. 2024

J Clin Cardiol

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Cardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality worldwide. Effective prevention and management strategies are essential to reduce the burden of CVDs. This review summarizes recent advances in the prevention and management of CVDs. In terms of prevention, lifestyle modifications, such as diet, exercise, and smoking cessation, remain important strategies. Pharmacological interventions, including statins, antiplatelet agents, and antihypertensive medications, have also shown benefits. Innovative approaches, such as genetic testing and risk stratification, targeted prevention strategies, and the use of mobile health technology, are being explored. In terms of management, acute management strategies, such as reperfusion therapy for myocardial infarction, acute heart failure management, and stroke management, have improved outcomes. Chronic management strategies, including medical therapy for heart failure, arrhythmia management, and device therapy for heart failure, have also shown benefits. Innovative approaches, such as precision medicine and personalized treatment, the use of artificial intelligence in diagnosis and treatment, and advances in traditional Chinese and regenerative medicine, are being investigated. While recent advances in the prevention and management of CVDs are promising, challenges remain in implementing these strategies, including cost-effectiveness, access to care, and resistance to change in clinical practice. Continued research and innovation are essential to reduce the burden of CVDs and improve patient outcomes.

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“…There are many potential reasons for under-dosing of GDMT. Clinical inertia, impracticality of frequent clinical visits, and patient factors have all been hypothesized to contribute [8,9]. Comprehensive disease management programs have been designed to provide targeted, specialized multidisciplinary care aimed at improving outcomes, via alleviating barriers to patient access, providing education, and promoting patient self-care.…”

Section: Introductionmentioning

confidence: 99%

Patient Perspectives on Digital Interventions to Manage Heart Failure Medications: The VITAL-HF Pilot

Samsky,

Leverty,

Gray

et al. 2023

JCM

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Use of guideline-directed medical therapy (GDMT) for treatment of heart failure with reduced ejection fraction (HFrEF) remains unacceptably low. The purpose of this study was to determine whether a digital health tool can augment GDMT for patients with HFrEF. Participants ≥ 18 years old with symptomatic HFrEF (left ventricular ejection fraction ≤ 40%) and with access to a mobile phone with internet were included. Participants were given a blood pressure cuff, instructed in its use, and given regular symptom surveys via cell-phone web-link. Data were transmitted to the Story Health web-based platform, and automated alerts were triggered based on pre-specified vital sign and laboratory data. Health coaches assisted patients with medication education, pharmacy access, and lab access through text messages and phone calls. GDMT titration plans were individually created in the digital platform by local clinicians based on entry vitals and labs. Twelve participants enrolled and completed the study. The median age and LVEF were 52.5 years (IQR, 46.5–63.5) and 25% (IQR, 22.5–35.5), respectively. There were 10 GDMT initiations, 52 up-titrations, and 13 down-titrations. Five participants engaged in focus-group interviews following study completion to understand first-hand perspectives regarding the use of digital tools to manage GDMT. Participants expressed comfort knowing that there were clinicians regularly reviewing their data. This alleviated concerns of uncertainty in daily living, led to an increased feeling of security, and empowered patients to understand decision-making regarding GDMT. Frequent medication changes, and the associated financial impact, were common concerns. Remote titration of GDMT for HFrEF is feasible and appears to be a patient-centered approach to care.

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Improving implementation of evidence‐based therapies for heart failure

Cited by 5 publications

References 43 publications

Knowledge and Practices regarding Guideline-directed Medical Therapy for Heart Failure with Reduced Ejection Fraction (HFrEF) among Physicians in Beijing, China: a Cross- sectional Study

Knowledge and Practices regarding Guideline-directed Medical Therapy for Heart Failure with Reduced Ejection Fraction (HFrEF) among Physicians in Beijing, China: a Cross- sectional Study

Shaping the Future of Cardiac Wellness: Exploring Revolutionary Approaches in Disease Management and Prevention

Patient Perspectives on Digital Interventions to Manage Heart Failure Medications: The VITAL-HF Pilot

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