Korean Circ J.  2023 May;53(5):294-312. 10.4070/kcj.2023.0024.

Treatment Strategies of Improving Quality of Care in Patients With Heart Failure

• Kim SE
• Yoo BS

• KMID: 2542300
• DOI: http://doi.org/10.4070/kcj.2023.0024

Abstract

Heart failure (HF) is a global health problem closely related to morbidity and mortality. As the burden of HF increases, it is necessary to manage and treat this condition well. However, there are differences between real-world practice and guidelines for the optimal treatment for HF. Patient-related, healthcare provider-related, and health system-related factors contribute to poor adherence to optimal care. This review article aims to examine HF treatment patterns and treatment adherence in real-world practice, identify clinical gaps to suggest ways to improve the quality of care for HF and clinical outcomes for patients with HF. Although it is important to optimize treatment based on evidence-based guidelines to the greatest extent, it is known that there is still poor treatment adherence, and many patients do not receive guideline-directed medical therapy, especially at the early stages. To improve medication adherence, qualitative evaluation through performance measurement, as well as education of patients, caregivers and medical staff through a multidisciplinary approach are important.

Keyword

Heart failure care; Performance measure; Multidisciplinary team approach

Figure

• 

  Figure 1 Guideline-directed medical therapy adherence in real-world practice.ACEI = angiotensin converting enzyme inhibitor; ARB = angiotensin receptor blocker; ARNI = angiotensin receptor/neprilysin inhibitor; BB = beta-blocker; CHAMP = Change the Management of Patients; ESC = European Society of Cardiology; EVITA-HF = Evidence Based Treatment - Heart Failure; EVOLUTION-HF = Utilization of Dapagliflozin and Other Guideline Directed Medical Therapies in Heart Failure Patients; HF = heart failure; MRA = mineralocorticoid antagonist; OPTIMIZE-HF = Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure; SGLT2I = sodium-glucose cotransporter-2 inhibitor; STRONG-HF = Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure Therapies; QUALIFY = Quality of Adherence to guideline recommendations for LIFe-saving treatment in heart failure surveY.*In-patients trial; †Multinational study; ‡Prospective randomized trial.

• 

  Figure 2 Guideline-directed medical therapy adherence in landmark randomized controlled trial.ACEI = angiotensin converting enzyme inhibitor; ARB = angiotensin receptor blocker; ARNI = angiotensin receptor/neprilysin inhibitor; BB = beta-blocker; DAPA-HF = Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure; EMPEROR-Reduced = Empagliflozin Outcome Trial in Patients with Chronic Heart Failure and Reduced Ejection Fraction; GALACTIC-HF = Global Approach to Lowering Adverse Cardiac Outcomes through Improving Contractility in Heart Failure; MRA = mineralocorticoid antagonist; SGLT2I = sodium-glucose cotransporter-2 inhibitor; VICTORIA = Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction.

• 

  Figure 3 Guideline-directed medical therapy prescription rates according to target dose.ACEI = angiotensin converting enzyme inhibitor; ARB = angiotensin receptor blocker; BB = beta-blocker; CHAMP = Change the Management of Patients; ESC = European Society of Cardiology; HF = heart failure; MRA = mineralocorticoid receptor antagonist; STRONG-HF = Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure Therapies; QUALIFY = Quality of Adherence to guideline recommendations for LIFe-saving treatment in heart failure surveY.*Multinational study; †Prospective randomized trial.

• 

  Figure 4 HF care from hospital to follow-up.ECG = electrocardiography; GDMT = guideline-directed medical therapy; HF = heart failure; LVEF = left ventricular ejection fraction; NP = natriuretic peptide.

• 

  Figure 5 Treatment strategies of improving quality of care in heart failure patients.BMI = body mass index; BP = blood pressure; COVID-19 = coronavirus disease 2019; HR = heart rate; GDMT = guideline-directed medical therapy.

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