Abstract:Introduction
Consideration of patient preferences for guideline-directed medical therapies (GDMT) for heart failure with reduced ejection fraction (HFrEF) may help improve major gaps in prescribing and adherence. This study aimed to identify the range and relative priority of factors influencing patients’ decisions to take HFrEF medications.
Materials and Methods
This was a convergent mixed methods study of patients with HFrEF. Focus groups were conducted to identify a … Show more
“…1 ), with a total of 854 participants. 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 We contacted the corresponding author of one article for additional information about study participant characteristics, but we did not receive a response. 29 Figure 1 P referred R eporting I tems for S ystematic Reviews and M eta- A nalyses (PRISMA) flow diagram.…”
Section: Resultsmentioning
confidence: 99%
“…Nine studies used qualitative methodology (8 interviews; 1 focus group), 2 used mixed-methods (1 conducted a focus group with attribute preference ranking; 1 conducted interviews plus a quantitative survey), and 2 employed quantitative surveys. All 13 studies enrolled patients with HF (primarily from outpatient clinics); 5 were restricted to patients with HFrEF 29 , 30 , 35 , 37 , 38 ; and 3 studies required patients to be taking cardiac or HF medications at enrollment. 28 , 31 , 32 , 34 The mean age of patient participants was 64 years; 33% were female; and most were White (mean: 73%) or Black (mean: 23%; Table 2 ).…”
Section: Resultsmentioning
confidence: 99%
“… 30 (2020) To understand the decisional needs and treatment preferences among patients with HF as they relate to medication cost US (2017) 49 Qualitative; Structured interview with thematic analysis ≥ 18 years old with HF with an EF < 40%, eligible for sacubitril/valsartan without a history of heart transplant, inotrope dependence, mechanical circulatory support, or dialysis dependence Via clinics or inpatient centre Trinkley et al. 37 (2020) To examine the decisional needs and treatment attribute preferences of patients with HF US (NR) 13 Mixed-methods; Semistructured focus groups with thematic analysis, attribute-preference ranking exercise Adults with HFrEF Via established clinical relationships with study investigator Venechuk et al. 33 (2020) To examine the perspectives of clinicians and patients with HF regarding a decision aid US (2017) 13 Qualitative; Semistructured interviews (patients), Email feedback (clinicians) HF patients eligible for or currently taking an ARNI Via clinics or patient advisory panel ARNI, angiotensin receptor-neprilysin inhibitor; ESRD, end-stage renal disease; GP, general practitioner; HF, heart failure; HFrEF, HF with reduced ejection fraction; NR, not reported; NYHA, New York Heart Association; UK, United Kingdom.…”
“…1 ), with a total of 854 participants. 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 We contacted the corresponding author of one article for additional information about study participant characteristics, but we did not receive a response. 29 Figure 1 P referred R eporting I tems for S ystematic Reviews and M eta- A nalyses (PRISMA) flow diagram.…”
Section: Resultsmentioning
confidence: 99%
“…Nine studies used qualitative methodology (8 interviews; 1 focus group), 2 used mixed-methods (1 conducted a focus group with attribute preference ranking; 1 conducted interviews plus a quantitative survey), and 2 employed quantitative surveys. All 13 studies enrolled patients with HF (primarily from outpatient clinics); 5 were restricted to patients with HFrEF 29 , 30 , 35 , 37 , 38 ; and 3 studies required patients to be taking cardiac or HF medications at enrollment. 28 , 31 , 32 , 34 The mean age of patient participants was 64 years; 33% were female; and most were White (mean: 73%) or Black (mean: 23%; Table 2 ).…”
Section: Resultsmentioning
confidence: 99%
“… 30 (2020) To understand the decisional needs and treatment preferences among patients with HF as they relate to medication cost US (2017) 49 Qualitative; Structured interview with thematic analysis ≥ 18 years old with HF with an EF < 40%, eligible for sacubitril/valsartan without a history of heart transplant, inotrope dependence, mechanical circulatory support, or dialysis dependence Via clinics or inpatient centre Trinkley et al. 37 (2020) To examine the decisional needs and treatment attribute preferences of patients with HF US (NR) 13 Mixed-methods; Semistructured focus groups with thematic analysis, attribute-preference ranking exercise Adults with HFrEF Via established clinical relationships with study investigator Venechuk et al. 33 (2020) To examine the perspectives of clinicians and patients with HF regarding a decision aid US (2017) 13 Qualitative; Semistructured interviews (patients), Email feedback (clinicians) HF patients eligible for or currently taking an ARNI Via clinics or patient advisory panel ARNI, angiotensin receptor-neprilysin inhibitor; ESRD, end-stage renal disease; GP, general practitioner; HF, heart failure; HFrEF, HF with reduced ejection fraction; NR, not reported; NYHA, New York Heart Association; UK, United Kingdom.…”
AimsDecision‐makers still predominantly focus on the perspective of non‐patient stakeholders, which may deviate from the unique perspective of heart failure (HF) patients. To enhance patient‐centred decision‐making, there is a need for more patient‐based evidence derived directly from the patients themselves. Hence, this study aimed to understand (i) HF patients' unmet medical needs and preferred treatment outcomes; (ii) patients' risk tolerance; and (iii) their information needs, uncertainties and satisfaction towards HF treatment.MethodsThis qualitative patient preference study consisted of a literature review with a systematic search strategy and semi‐structured interviews with HF patients, analysed using the framework method. During the interviews, patients were asked to rank a predefined list of disease and treatment‐related characteristics informed by the literature review and were able to spontaneously raise additional characteristics.ResultsThe study included 14 Belgian HF patients (age range: 58–79, mean age: 72). (i) Regarding their unmet medical needs, HF patients reported that the most important unmet medical needs were shortness of breath and fatigue, as they negatively impact their quality of life (QoL) and independence. In the ranking exercise, patients prioritized improvements in QoL over improvements in life expectancy, whereby the following characteristics received the highest cumulative score: (1) independence, (2) shortness of breath, (3) impaired renal function, (4) survival, (5) fatigue, (6) risk of hospitalization and (7) communication with and between physicians. Patients most often spontaneously raise characteristics related to the general care process. Mechanism of action, route of administration, dose frequency and weight fluctuations scored among the least important characteristics. (ii) Regarding patients' risk tolerance towards HF treatment, some of the patients expressed zero tolerance for side effects, as they had not yet experienced any discomfort caused by the treatment or disease. (iii) Regarding their information needs, patients voiced their desire to receive practical and comprehensible advice orally from their physician because they highly value individualized treatment decision‐making. Patients also expressed uncertainties regarding whether the experienced effects were due to their treatment, disease, ageing or other comorbidities.ConclusionsThis study shows that, besides increasing life expectancy, HF patients prioritize improvements in symptoms and side effects reducing their QoL and independence, such as shortness of breath and fatigue. The patient‐relevant characteristics identified in this study, from the perspective of HF patients themselves, may be useful to inform clinical trial endpoint selection and guide downstream drug development, evaluation and clinical decision‐making towards addressing the unmet medical needs and treatment outcomes of importance to HF patients.
The delayed titration of guideline-directed drug therapy (GDMT) is a complex event influenced by multiple factors that often result in poor prognosis for patients with heart failure (HF). Individualized adjustments in GDMT titration may be necessary based on patient characteristics, and every clinician is responsible for promptly initiating GDMT and titrating it appropriately within the patient’s tolerance range. This review examines the current challenges in GDMT implementation and scrutinizes titration considerations within distinct subsets of HF patients, with the overarching goal of enhancing the adoption and effectiveness of GDMT. The authors also underscore the significance of establishing a novel management strategy that integrates cardiologists, nurse practitioners, pharmacists, and patients as a unified team that can contribute to the improved promotion and implementation of GDMT.
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