This review describes multiple implementation strategies, including in-hospital initiation and virtual consults, to improve the utilization of guideline-directed medical therapy for HFrEF.
Patients with heart failure with reduced ejection fraction (HFrEF)
Implementation strategies for guideline-directed medical therapy (GDMT) including in-hospital initiation, rapid sequence initiation, quality improvement registries, multidisciplinary titration clinics, virtual consult teams, reduction of cost-sharing, remote algorithm-based medication optimization, electronic health record-based interventions, and direct-to-patient educational initiatives
Multiple implementation strategies, including in-hospital initiation and multidisciplinary clinics, are supported by evidence to improve the utilization of GDMT in patients with HFrEF.
Despite the availability of lifesaving guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF), there remain major gaps in utilization of these therapies among eligible patients. Simultaneous with these gaps in quality of care, HFrEF continues as a leading cause of death and hospitalization with associated clinical risk far exceeding most other cardiovascular and noncardiovascular conditions. In the context of this urgent need to improve provision of appropriate therapy, multiple lines of evidence support various implementation strategies. Such strategies include in-hospital initiation of GDMT, simultaneous or rapid sequence initiation of GDMT, participation in quality improvement registries to assess site performance and provide feedback, multidisciplinary titration clinics, virtual consult teams, reduction of cost-sharing, remote algorithm-based medication optimization, electronic health record-based interventions, and direct-to-patient educational initiatives. This review describes and contextualizes the evidence surrounding each of these potential avenues for improving use of foundational GDMTs for patients with HFrEF.
“The strikingly low utilization of MRA and newer therapies such as ARNI and SGLT2i indicate a critical need for strategies to enhance GDMT”
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Harsh Patolia
Muhammad Shahzeb Khan
Gregg C. Fonarow
Journal of the American College of Cardiology
University of California, Los Angeles
Duke University
Duke University Hospital
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Patolia et al. (Mon,) conducted a review in Heart failure with reduced ejection fraction (HFrEF). Guideline-directed medical therapy (GDMT) implementation strategies was evaluated. This review describes multiple implementation strategies, including in-hospital initiation and virtual consults, to improve the utilization of guideline-directed medical therapy for HFrEF.
www.synapsesocial.com/papers/69e598da85ab6d890cfade3d — DOI: https://doi.org/10.1016/j.jacc.2023.03.430
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