Primary care Adherence To Heart failure guidelines in post-Discharge, Evaluation & Routine management (PATHFINDER): a randomised controlled trial

Abstract Background and aims Heart failure (HF) management guidelines offer evidence-based recommendations but can be difficult to implement in primary care. This randomised controlled trial evaluated a multifaceted intervention to improve adherence to pharmacological and non-pharmacological HF management guidelines in primary care. Methods and results Patients hospitalised with HF were randomised 1:1 to an intervention or control group. The intervention group received guideline-based inpatient education, a post-discharge plan including referral to cardiac rehabilitation (CR) and scheduled general practitioner follow-ups at 1 and 4 weeks, and 3 months, supported by a cardiologist-approved medication titration plan. The control group received usual care. The primary outcome, measured at 6 months, was adherence to five recommended treatments: i) ACEI/ARB/ARNI ≥50% target dose, ii) beta blocker ≥50% target dose, iii) MRA at any dose, iv) anticoagulation for atrial fibrillation, and v) CR referral. Adherence was compared using Chi-squared tests and logistic regression. Of 225 participants (25% female), a greater proportion in the intervention group achieved the primary outcome (61.8% vs. 28.7%; p0.01). The unadjusted odds ratio showed that the intervention group was 6.27 times more likely to achieve the outcome compared to the control group (95% CI, 3.35-11.76, p0.01). This difference was driven by higher prescription rates of ACEI/ARB/ARNI and beta blocker, and higher referral rates to CR. Conclusion Hospital-based support for HF-management in primary care improved adherence to pharmacological and non-pharmacological components of guideline-recommended care. Greater implementation of transitional care processes of this nature has the potential to improve clinical outcomes for patients with HF.