A PACT for the future: Improving medication adherence in heart failure

Abstract

This article refers to 'Effect of a transitional care model following hospitalization for heart failure: 3-year outcomes of the Patient-Centered Care Transitions in Heart Failure (PACT-HF) randomized controlled trial' by T. Averbuch et al., published in this issue on pages 652-660.Heart failure (HF) currently affects over 64 million people worldwide, placing a growing burden on health care systems due to the costs of disease management and downstream complications. 1,2 Contemporary observational studies have highlighted the ongoing underutilization of guideline-directed medical therapy (GDMT) as a driving factor for HF morbidity and mortality, while concurrently emphasizing gaps in knowledge on reducing readmissions and morbidity via medication adherence optimization. For instance, the CHAMP-HF study identified significant percentages of outpatient HF patients that were not on eligible GDMT classes, and more concerningly found minimal improvement in medication initiation and titration during follow-up. 3 This pattern persists despite significant evidence from studies such as STRONG-HF, which demonstrated that rapid, high-intensity titration of GDMT with close outpatient follow-up after an initial HF exacerbation was associated with reduced mortality and readmission risk. 4 Transitional HF care programmes have therefore gained interest as a mechanism to facilitate GDMT titration and ensure appropriate monitoring of patients in the vulnerable post-discharge period. In this issue of the Journal, Averbuch and colleagues revisit the results from the PACT-HF trial 3 years post-implementation, reviewing the long-term impacts of a transitional care model on HF mortality, hospital and emergency department (ED) readmissions, as well as its impact on the uptake and utilization of GDMT. 5 The PACT-HF study was a stepped-wedge cluster randomized trial of 2494 patients across 10 hospitals which studied the impact of a patient-centred transitional care model on all-cause deaths, ED visits, and readmissions.