Despite the availability of lifesaving guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF), there remain major gaps in utilization of these therapies among eligible patients. Simultaneous with these gaps in quality of care, HFrEF continues as a leading cause of death and hospitalization with associated clinical risk far exceeding most other cardiovascular and noncardiovascular conditions. In the context of this urgent need to improve provision of appropriate therapy, multiple lines of evidence support various implementation strategies. Such strategies include in-hospital initiation of GDMT, simultaneous or rapid sequence initiation of GDMT, participation in quality improvement registries to assess site performance and provide feedback, multidisciplinary titration clinics, virtual consult teams, reduction of cost-sharing, remote algorithm-based medication optimization, electronic health record-based interventions, and direct-to-patient educational initiatives. This review describes and contextualizes the evidence surrounding each of these potential avenues for improving use of foundational GDMTs for patients with HFrEF.
Keyphrases
- quality improvement
- heart failure
- healthcare
- electronic health record
- patient safety
- end stage renal disease
- adverse drug
- primary care
- ejection fraction
- newly diagnosed
- chronic kidney disease
- left ventricular
- prognostic factors
- atrial fibrillation
- peritoneal dialysis
- clinical decision support
- case report
- stem cells
- acute heart failure
- deep learning
- health information
- pain management
- patient reported outcomes
- climate change
- acute care
- patient reported
- mesenchymal stem cells
- smoking cessation
- replacement therapy