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Patient Perceptions and Familiarity With Medical Therapy for Heart Failure
Marc D Samsky1,2, Li Lin1, Stephen J Greene1,2
1Duke Clinical Research Institute, Durham, North Carolina.
Insights
Many heart failure patients lack awareness of guideline-directed medical therapy (GDMT), especially newer drugs. Patient education and shared decision-making are crucial for improving GDMT use in heart failure care.
Area of Science:
- Cardiology
- Patient-Reported Outcomes
- Pharmacotherapy
Background:
- Guideline-directed medical therapy (GDMT) significantly improves outcomes for patients with heart failure (HF).
- However, substantial gaps exist in the utilization of GDMT in clinical practice.
- Patient perspectives on GDMT, including their goals and preferences, are largely unaddressed.
Purpose of the Study:
- To survey patients with chronic heart failure (HF) to understand their experiences.
- To assess patient familiarity and concerns regarding guideline-directed medical therapy (GDMT) for HF.
- To identify barriers to GDMT uptake from the patient's viewpoint.
Main Methods:
- A survey was administered to a representative sample of US adults with a diagnosis of HF and currently on HF medications.
- The survey explored disease-related goals, challenges of living with HF, medication decision-making, and awareness/concerns about HF therapies.
- Data were collected from 429 participants via the GfK KnowledgePanel between October and November 2018.
Main Results:
- Most surveyed patients were familiar with older HF medications like beta-blockers and diuretics.
- Familiarity was notably lower for newer therapies, including angiotensin receptor-neprilysin inhibitors (24.9%) and mineralocorticoid receptor antagonists (24.9%).
- Significant proportions of patients expressed concerns about the safety (up to 42.5%) and effectiveness (up to 41%) of various GDMT classes.
Conclusions:
- A considerable number of heart failure patients demonstrate limited familiarity with guideline-directed medical therapy (GDMT).
- Lack of familiarity correlates with concerns regarding the safety and efficacy of these essential HF treatments.
- Improving patient education and implementing shared decision-making strategies are vital for enhancing GDMT adoption in heart failure management.
Importance:
There are major gaps in use of guideline-directed medical therapy (GDMT) for patients with heart failure (HF). Patient-reported data outlining patient goals and preferences associated with GDMT are not available.
Objective:
To survey patients with chronic HF to better understand their experiences and perceptions of living with HF, including their familiarity and concerns with important GDMT therapies.
Design, Setting, And Participants:
Study participants were recruited from the GfK KnowledgePanel, a probability-sampled online panel representative of the US adult population. English-speaking adults who met the following criteria were eligible if they were (1) previously told by a physician that they had HF; (2) currently taking medications for HF; and (3) had no history of left ventricular assist device or cardiac transplant. Data were collected between October and November 2018. Analysis began in December 2018.
Main Outcomes And Measures:
The survey included 4 primary domains: (1) relative importance of disease-related goals, (2) challenges associated with living with HF, (3) decision-making process associated with HF medication use, and (4) awareness and concerns about available HF medications.
Results:
Of 30 707 KnowledgePanel members who received the initial survey, 15 091 (49.1%) completed the screening questions, 440 were eligible and began the survey, and 429 completed the survey. The median (interquartile range) age was 68 (60-75) years and most were white (320 [74.6%]), male (304 [70.9%]), and had at least a high school education (409 [95.3%]). Most survey responders reported familiarity with β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. Overall, 107 (24.9%) reported familiarity with angiotensin receptor-neprilysin inhibitors or mineralocorticoid receptor antagonists. Overall, 136 patients (42.5%) reported have safety concerns regarding angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and 133 (38.5%) regarding β-blockers, 35 (37.9%) regarding mineralocorticoid receptor antagonists, 38 (36.5%) regarding angiotensin receptor-neprilysin inhibitors, and 123 (37.2%) regarding diuretics. Between 27.7% (n = 26) and 38.5% (n = 136) reported concerns regarding the effectiveness of β-blockers, angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, or diuretics, while 41% (n = 132) were concerned with the effectiveness of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers.
Conclusions And Relevance:
In this survey study, many patients were not familiar with GDMT for HF, with familiarity lowest for angiotensin receptor-neprilysin inhibitors and mineralocorticoid receptor antagonists. Among patients not familiar with these therapies, significant proportions questioned their effectiveness and/or safety. Enhanced patient education and shared decision-making support may be effective strategies to improve the uptake of GDMT for HF in US clinical practice.
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