Key result
Mnemonic trigger systems may improve underutilized referral for FDA-approved heart failure devices.
Why the study?
Despite the benefits of guideline-directed medical therapy in heart failure, residual risk remains high and device therapies are underutilized due to lack of clinical awareness and access.
This review highlights the underutilization of FDA-approved heart failure devices and proposes a mnemonic trigger system to improve patient referral and evaluation.
May lower residual HF risk via devices; leaves open need for randomized confirmation.
The use of guideline-directed medical therapy (GDMT) has substantially prolonged and improved the lives of patients with heart failure (HF). Nevertheless, adherence rates remain suboptimal. Even when successfully maximized and adhered to, there is a substantial residual risk of recurrent HF hospitalization and death. In light of this, there is a strong need for effective interventions that can decrease the high residual risk seen in patients with HF. Several device options exist that are approved by the US Food and Drug Administration and that have been shown to decrease morbidity and/or mortality in patients among whom GDMT is maximized. These strategies include valvular interventions (aortic valve replacement, mitral valve repair, and tricuspid valve repair or replacement), cardiac resynchronization, cardiac contractility modulation, remote hemodynamic monitoring, and baroreceptor activation therapy. The pivotal trials for each of these interventions, and the patient populations for which they have been approved, are discussed. Current rates of device use in clinical practice remain very low. For many device classes, the vast majority of eligible patients are not offered or prescribed the device. Several reasons may explain this mismatch, foremost of which is a lack of clinical awareness about when to escalate therapy, how to identify patients requiring more than GDMT, and access to centers with sufficient experience. To aid the appropriate uptake of device therapy in clinical practice, we propose a simple mnemonic for use by clinicians that can prompt the early identification and prompt referral of patients with HF who likely merit consideration of additional device-based therapy in addition to GDMT.
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Fudim et al. (2025) conducted a review in Heart failure. Heart failure devices was evaluated. A review of FDA-approved heart failure devices highlights their underutilization in clinical practice and proposes a mnemonic trigger system to prompt early identification and referral of eligible patients.
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