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Related Concept Videos

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

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The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
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Related Experiment Video

Updated: May 23, 2025

Author Spotlight: Workflow for Integrating POCUS Data into EHR for Managing Heart Failure Patients
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Author Spotlight: Workflow for Integrating POCUS Data into EHR for Managing Heart Failure Patients

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Multiregional Implementation Initiative's Impact on Guideline-Based Performance Measures for Patients Hospitalized

Andrew J Sauer1, Chandler Beon2, Sruthi Cherkur2

  • 1Saint Luke's Mid-America Heart Institute, Kansas City, MO (A.J.S., J.S.).

Circulation. Heart Failure
|March 21, 2025
PubMed
Summary

Quadruple medical therapy (QMT) use significantly increased in heart failure patients through the IMPLEMENT-HF quality improvement initiative. This collaborative approach enhanced guideline-directed medical therapy adherence in routine practice.

Keywords:
guidelineheart failurehospitalsquality improvementsocial determinants of health

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Area of Science:

  • Cardiology
  • Health Services Research
  • Quality Improvement

Background:

  • Quadruple medical therapy (QMT) offers survival benefits for heart failure with reduced ejection fraction (HFrEF) but is underutilized.
  • The IMPLEMENT-HF initiative aimed to improve HFrEF care by increasing QMT adoption in clinical practice.

Purpose of the Study:

  • To evaluate the effectiveness of the IMPLEMENT-HF quality improvement initiative in enhancing QMT utilization for HFrEF patients.
  • To assess changes in QMT adherence and identify variations in care across different regions.

Main Methods:

  • Analysis of HFrEF patients from 61 hospitals participating in the American Heart Association's Get With The Guidelines-HF and IMPLEMENT-HF.
  • Multiregional quality improvement collaborative using multidisciplinary learning and site-level feedback.
  • Data collection on QMT utilization at discharge and 30 days post-discharge from Q1 2021 to Q2 2023.

Main Results:

  • Defect-free QMT use at discharge increased from 4.7% to 44.6% (P<0.0001).
  • QMT use at 30 days post-discharge improved from 0% to 44.8% (P<0.0001).
  • Improvements were consistent across demographic groups, but significant regional variations persisted.

Conclusions:

  • The IMPLEMENT-HF initiative demonstrated a marked increase in QMT use among eligible HFrEF patients.
  • A learning collaborative model effectively promotes improvements in guideline-directed medical therapy adherence.
  • Quality improvement initiatives are vital for translating evidence-based treatments into routine cardiovascular care.