Implementation Science to Achieve Equity in Heart Failure Care: A Scientific Statement From the American Heart...

Area of Science:

• Implementation science
• Cardiovascular medicine
• Health equity

Background:

• Guideline-directed medical and nonpharmacological therapies significantly improve quality of life and survival in heart failure (HF) patients.
• Despite proven benefits, eligible patients, particularly women and underrepresented racial and ethnic groups, are often undertreated with these evidence-based therapies.
• Implementation science offers frameworks to bridge the gap between evidence and practice, aiming to improve health outcomes.

Purpose of the Study:

• To provide an overview of implementation trials in heart failure (HF).
• To assess the utilization of conceptual frameworks and health equity principles in HF implementation research.
• To offer pragmatic guidance for advancing health equity in HF care.

Main Methods:

• Review of existing implementation trials in heart failure.
• Assessment of studies for their incorporation of theoretical frameworks and health equity considerations.
• Analysis of strategies used to promote uptake of guideline-directed therapies.

Main Results:

• Behavioral nudges, multidisciplinary care, and digital health strategies effectively increased therapy uptake in HF but often lacked specific equity goals.
• Few HF studies have comprehensively addressed equity by engaging stakeholders, identifying barriers/facilitators, developing theory-informed strategies, or evaluating equity-focused implementation measures.
• Existing HF equity studies demonstrate feasibility in using educational strategies for organizational change and equitable care, with ongoing pragmatic trials exploring HF equity.

Conclusions:

• There is a critical need for more heart failure implementation trials specifically designed to promote equitable delivery of guideline-directed therapy.
• Current implementation strategies in HF, while effective for uptake, require refinement to explicitly incorporate and achieve health equity goals.
• Further research and pragmatic trials are essential to address disparities and ensure all HF patients receive optimal, equitable care.