How to tackle therapeutic inertia in heart failure with reduced ejection fraction. A scientific statement of the
Gianluigi Savarese1,2, Felix Lindberg1, Antonio Cannata3,4
1Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
European Journal of Heart Failure
|May 23, 2024
Summary
Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) is underused. This statement outlines strategies to overcome barriers and improve treatment implementation, enhancing patient outcomes.
Area of Science:
- Cardiology
- Clinical Practice Guidelines
- Heart Failure Management
Background:
- Guideline-directed medical therapy (GDMT) significantly reduces morbidity and mortality in heart failure with reduced ejection fraction (HFrEF).
- Poor implementation of GDMT in routine clinical practice is a major challenge.
- Clinical inertia, characterized by delayed or avoided treatment initiation/optimization, contributes to suboptimal GDMT use.
Purpose of the Study:
- To provide an overview of current GDMT implementation in HFrEF.
- To identify clinical and organizational barriers hindering GDMT uptake.
- To propose a framework for overcoming clinical inertia and improving GDMT implementation.
Main Methods:
- Review of current evidence on GDMT implementation in HFrEF.
- Analysis of clinical and organizational barriers to treatment adherence.
- Synthesis of strategies to enhance GDMT delivery.
Main Results:
- Several strategies can foster GDMT implementation, including optimized care pathways, tailored drug regimens, digital health tools, and educational initiatives.
- Addressing patient and physician awareness is crucial.
- Quality registries can monitor and improve adherence.
Conclusions:
- Improving GDMT implementation in HFrEF requires a multifaceted approach addressing care organization, treatment strategies, technology, and education.
- Overcoming clinical inertia is key to maximizing the benefits of GDMT for HFrEF patients.
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