How to tackle therapeutic inertia in heart failure with reduced ejection fraction. A scientific statement of the Heart Failure Association of the ESC

Gianluigi Savarese, Félix Lindberg, Antonio Cannata, Ovideu Chioncel, Davide Stolfo, Francesca Musella, Daniela Tomasoni, Magdy Abdelhamid, Debasish Banerjee, Antoni Bayes-Genis, Emmanuelle Berthelot, Frieder Braunschweig, Andrew J.S. Coats, Nicolas Girerd, Ewa A. Jankowska, Loreena Hill, Mitja Lainscak, Yury Lopatin, Lars H. Lund, Aldo P. MaggioniBrenda Moura, Amina Rakisheva, Robin Ray, Petar M. Seferovic, Hadi Skouri, Cristiana Vitale, Maurizio Volterrani, Marco Metra, Giuseppe M.C. Rosano

Research output: Contribution to journalArticleResearchpeer-review

15 Citations (Web of Science)

Abstract

Guideline-directed medical therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF) reduces morbidity and mortality, but its implementation is often poor in daily clinical practice. Barriers to implementation include clinical and organizational factors that might contribute to clinical inertia, i.e. avoidance/delay of recommended treatment initiation/optimization. The spectrum of strategies that might be applied to foster GDMT implementation is wide, and involves the organizational set-up of heart failure care pathways, tailored drug initiation/optimization strategies increasing the chance of successful implementation, digital tools/telehealth interventions, educational activities and strategies targeting patient/physician awareness, and use of quality registries. This scientific statement by the Heart Failure Association of the ESC provides an overview of the current state of GDMT implementation in HFrEF, clinical and organizational barriers to implementation, and aims at suggesting a comprehensive framework on how to overcome clinical inertia and ultimately improve implementation of GDMT in HFrEF based on up-to-date evidence.
Original languageEnglish
Pages (from-to)1278-1297
Number of pages20
JournalEuropean Journal of Heart Failure
Volume26
Issue number6
DOIs
Publication statusPublished - Jun 2024

Keywords

  • Clinical inertia
  • Guidelines-directed medical therapy
  • Heart failure
  • Heart failure with reduced ejection fraction
  • Implementation

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