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Developing a Multilevel Polypill Implementation Bundle for Patients With Heart Failure With Reduced Ejection Fraction
Justin C Chen1, Colette DeJong2, Mansi Agarwal3
1Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
JACC. Advances
|October 9, 2025
Summary
A new polypill strategy for heart failure with reduced ejection fraction (HFrEF) can improve patient outcomes. This study identified key factors and developed an implementation bundle to guide its use in HFrEF care.
Area of Science:
- Cardiology
- Implementation Science
- Health Services Research
Background:
- Polypills containing guideline-directed medical therapies for heart failure with reduced ejection fraction (HFrEF) show promise for improving patient outcomes.
- However, the factors influencing the successful implementation of polypill-based strategies for HFrEF remain largely unknown.
Purpose of the Study:
- To identify determinants impacting polypill-based strategies for HFrEF.
- To design a multilevel implementation bundle for HFrEF polypills.
- To illustrate how this bundle can enhance patient outcomes.
Main Methods:
- A convergent parallel mixed methods study was conducted with patients (N=9) and providers (N=22) at two institutions.
- The Consolidated Framework for Implementation Research v2.0 guided data collection on polypill-based HFrEF care.
- A matching tool and mechanism mapping were used to develop the implementation bundle.
Main Results:
- Four key themes emerged from stakeholder interviews, including the current state of HFrEF care, awareness of innovations, assessing innovation appropriateness, and building competency.
- These themes informed the development of a 7-domain multilevel HFrEF polypill implementation bundle.
- A directed acyclic graph illustrates the potential impact of the bundle on patient outcomes.
Conclusions:
- A multilevel HFrEF polypill implementation bundle was developed.
- This bundle offers a framework for improving HFrEF care, particularly in undertreated populations.
- Further tailoring of the bundle can optimize its global application.
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