Novel Strategies to Improve Prescription of Guideline-Directed Medical Therapy in Heart Failure

Brooksbank, Jeremy; Faulkenberg, Kathleen D.; Tang, W.H. Wilson; Martyn, Trejeeve

doi:10.1007/s11936-023-00979-4

Cited by 8 publications

(4 citation statements)

References 68 publications

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“…A full set of search terms and strategies for each database can be found in eMethods in the Supplement. Sources from related reviews were also screened for possible inclusion …”

Section: Methodsmentioning

confidence: 99%

Interventions for Optimization of Guideline-Directed Medical Therapy

Tang,

Brownell,

Roberts

et al. 2024

JAMA Cardiol

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ImportanceImplementation of guideline-directed medical therapy (GDMT) in real-world practice remains suboptimal. It is unclear which interventions are most effective at addressing current barriers to GDMT in patients with heart failure with reduced ejection fraction (HFrEF).ObjectiveTo perform a systematic review to identify which types of system-level initiatives are most effective at improving GDMT use among patients with HFrEF.Evidence ReviewPubMed, Embase, Cochrane, CINAHL, and Web of Science databases were queried from January 2010 to November 2023 for randomized clinical trials that implemented a quality improvement intervention with GDMT use as a primary or secondary outcome. References from related review articles were also included for screening. Quality of studies and bias assessment were graded based on the Cochrane Risk of Bias tool and Oxford Centre for Evidence-Based Medicine.FindingsTwenty-eight randomized clinical trials were included with an aggregate sample size of 19 840 patients. Studies were broadly categorized as interdisciplinary interventions (n = 15), clinician education (n = 5), electronic health record initiatives (n = 6), or patient education (n = 2). Overall, interdisciplinary titration clinics were associated with significant increases in the proportion of patients on target doses of GDMT with a 10% to 60% and 2% to 53% greater proportion of patients on target doses of β-blockers and renin-angiotensin-aldosterone system inhibitors, respectively, in intervention groups compared with usual care. Other interventions, such as audits, clinician and patient education, or electronic health record alerts, were also associated with some improvements in GDMT utilization, though these findings were inconsistent across studies.Conclusions and RelevanceThis review summarizes interventions aimed at optimization of GDMT in clinical practice. Initiatives that used interdisciplinary teams, largely comprised of nurses and pharmacists, most consistently led to improvements in GDMT. Additional large, randomized studies are necessary to better understand other types of interventions, as well as their long-term efficacy and sustainability.

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“…A full set of search terms and strategies for each database can be found in eMethods in the Supplement. Sources from related reviews were also screened for possible inclusion …”

Section: Methodsmentioning

confidence: 99%

Interventions for Optimization of Guideline-Directed Medical Therapy

Tang,

Brownell,

Roberts

et al. 2024

JAMA Cardiol

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“…Finally, guidelines and recommendations pose a challenge to the optimization of treatment because they are not particularly patient-centred and do not necessarily acknowledge the challenges of a real-world population. 72,73 Hence, understanding and addressing these components might improve overall outcomes of patients with HFrEF.…”

Section: Factors Associated With Suboptimal Treatment: Potential Caus...mentioning

confidence: 99%

Optimization of GDMT for patients with heart failure and reduced ejection fraction: can physiological and biological barriers explain the gaps in adherence to heart failure guidelines?

Jarjour,

Ducharme

2023

DIC

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Heart failure is a growing epidemic with high mortality rates and recurrent hospital admissions that creates a burden on affected individuals, their caregivers and the whole healthcare system. Throughout the years, many randomized trials have established the effectiveness of several pharmacological therapies and electrophysiological devices to reduce hospitalizations and improve quality of life and survival, mostly for patients with heart failure with reduced ejection fraction (HFrEF). These studies led to the publication of national societies' recommendations to guide clinicians in the management of HFrEF. Yet, many reports have shown significant care gaps in adherence to these recommendations in clinical practice, highlighting suboptimal use and/or dosing of evidence-based therapies. Adherence to guidelines has been shown to be associated with the best prognosis in HFrEF, with patients presenting with intolerances or contraindications having the highest risk of events; however, it remains unclear whether this association is causal or merely a marker of more advanced disease. Furthermore, individual characteristics may limit the possibility of reaching the targeted dosage of specific agents. Herein, we provide a comprehensive overview of clinicians' adherence to heart failure guidelines in a specialized real-life setting, particularly regarding use and optimization of guideline-derived medical therapies, as well as the implementation of more recent agents such as sacubitril/valsartan and SGLT2 inhibitors. We seek potential explanations for suboptimal treatment and its impact on patient outcomes.

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“…As of 2022, the most proposed modern pharmacologic therapies consist of a comprehensive four drug regimen consisting of beta-blockers, sodium-glucose cotransporter-2 inhibitors (SGLT2i), mineralocorticoid receptor antagonists (MRA), and angiotensin receptor-neprilysin inhibitors(ARNI) 1 .…”

Section: Introductionmentioning

confidence: 99%

An Observational Study on Guideline Mediated Prescribing Pattern in Patients with Acute Decompensated Heart Failure

Rama Rao,

Sravya,

Akshaya

et al. 2024

Int J Med Sci Pharm Res

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Introduction: Studies on prescribing patterns are useful investigative instruments for figuring out how drugs function in society. Examining the prescription pattern is a crucial part of gauging the ability of medical professionals to choose a medication that will benefit patients to the fullest. The current study goals were to evaluate, using accepted guidelines, the general medicine department's practice of prescribing in accordance with guidelines in a tertiary care hospital and to assess the inclusion of drugs from essential drug list patients with acute decompensated heart failure. Methodology: Hospital based prospective case observational study was conducted for a period of six months after obtaining the permission from institutional ethical committee. The data was collected and analysed according to the inclusion and exclusion criteria and necessary statistical testing like chi square test and pearson correlation were performed. Results and Discussion: Based on the study, the data of total 100 patients (n=100) were evaluated. Gender distribution of data shows high prevalence rate in males. The most commonly high susceptibility of disease age was found in 40-60 in males and females. The maximum number of patients were hospitalized for 6-7 days, hypertension was the most commonly found precipitating factor. Diuretics were prescribed maximum in the prescription. Out of 650 drugs the maximum number of drugs fall under the category of Anti-hypertensives. Most drugs are given through oral route. The American heart association (AHA) guidelines were assessed for drug prescription using IBM SPSS Statistics. It was depicted that most of the prescriptions were in compliance with the guidelines. Conclusion: The results of our study conclude that prescribing practices were satisfactory according to the American college of cardiology guidelines. Keywords: Prescribing pattern, Guidelines, Acute heart failure, Anti-hypertensives.

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Novel Strategies to Improve Prescription of Guideline-Directed Medical Therapy in Heart Failure

Cited by 8 publications

References 68 publications

Interventions for Optimization of Guideline-Directed Medical Therapy

Interventions for Optimization of Guideline-Directed Medical Therapy

Optimization of GDMT for patients with heart failure and reduced ejection fraction: can physiological and biological barriers explain the gaps in adherence to heart failure guidelines?

An Observational Study on Guideline Mediated Prescribing Pattern in Patients with Acute Decompensated Heart Failure

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