Use of Human-Centered Design Methodology to Develop a Digital Toolkit to Optimize Heart Failure Guideline-Directed Medical Therapy

Abstract

Background Guideline-directed medical therapies (GDMTs) improve quality of life and health outcomes for patients with heart failure (HF). However, GDMT utilization is suboptimal among patients with HF. Objective The aims of this study were to engage key stakeholders in semistructured, virtual human-centered design sessions to identify challenges in GDMT optimization posthospitalization and inform the development of a digital toolkit aimed at optimizing HF GDMTs. Methods For the human-centered design sessions, we recruited (a) clinicians who care for patients with HF across 3 hospital systems, (b) patients with HF with reduced ejection fraction (ejection fraction ≤ 40%) discharged from the hospital within 30 days of enrollment, and (c) caregivers. All participants were 18 years or older, English speaking, with Internet access. Results A total of 10 clinicians (median age, 37 years [interquartile range, 35–41], 12 years [interquartile range, 10–14] of experience caring for patients with HF, 80% women, 50% White, 50% nurse practitioners) and three patients and one caregiver (median age 57 years [IQR: 53–60], 75% men, 50% Black, 75% married) were included. Five themes emerged from the clinician sessions on challenges to GDMT optimization (eg, barriers to patient buy-in). Six themes on challenges (eg, managing medications), 4 themes on motivators (eg, regaining independence), and 3 themes on facilitators (eg, social support) to HF management arose from the patient and caregiver sessions. Conclusions The clinician, patient, and caregiver insights identified through human-centered design will inform a digital toolkit aimed at optimizing HF GDMTs, including a patient-facing smartphone application and clinician dashboard. This digital toolkit will be evaluated in a multicenter, clinical trial.

Advances in the Science of Heart Failure Self-care

“…Patients who take their prescribed medications are less likely to be hospitalized compared with those who are nonadherent. Thus, the efforts of Spaulding et al 27 to promote guideline-directed medical therapy are a critical element of HF self-care. Using a co-design approach, the investigators sought to design an intervention to promote patient activation, engagement, and shared decision making to optimize guideline-directed medical therapy, arguing that interventions that combine clinician and patient-facing instruments have the potential to improve guideline-directed medical therapy and patient outcomes.…”