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SeferoviĆ PM, Polovina M, Adlbrecht C, et al. Navigating between Scylla and Charybdis: challenges and strategies for implementing guideline-directed medical treatment in heart failure with reduced ejection fraction. Eur J Heart Fail. 2021;doi: 10.1002/ejhf.2378.
SeferoviĆ, P. M., Polovina, M., Adlbrecht, C., BĚlohlávek, J., Chioncel, O., Goncalvesová, E., MilinkoviĆ, I., Grupper, A., Halmosi, R., Kamzola, G., Koskinas, K. C., Lopatin, Y., Parkhomenko, A., Põder, P., RistiĆ, A. D., Šakalyt, G., TrbušiĆ, M., Tundybayeva, M., Vrtovec, B., Yotov, Y. T., MiličiĆ, D., Ponikowski, P., Metra, M., Rosano, G., & Coats, A. J. (2021). Navigating between Scylla and Charybdis: challenges and strategies for implementing guideline-directed medical treatment in heart failure with reduced ejection fraction. European journal of heart failure, . https://doi.org/10.1002/ejhf.2378
SeferoviĆ, Petar M, et al. "Navigating between Scylla and Charybdis: challenges and strategies for implementing guideline-directed medical treatment in heart failure with reduced ejection fraction." European journal of heart failure vol. (2021). doi: https://doi.org/10.1002/ejhf.2378
SeferoviĆ PM, Polovina M, Adlbrecht C, BĚlohlávek J, Chioncel O, Goncalvesová E, MilinkoviĆ I, Grupper A, Halmosi R, Kamzola G, Koskinas KC, Lopatin Y, Parkhomenko A, Põder P, RistiĆ AD, Šakalyt G, TrbušiĆ M, Tundybayeva M, Vrtovec B, Yotov YT, MiličiĆ D, Ponikowski P, Metra M, Rosano G, Coats AJ. Navigating between Scylla and Charybdis: challenges and strategies for implementing guideline-directed medical treatment in heart failure with reduced ejection fraction. Eur J Heart Fail. 2021 Nov 09; doi: 10.1002/ejhf.2378. Epub 2021 Nov 09. PMID: 34755422.
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Eur J Heart Fail. 2021 Nov 09; doi: 10.1002/ejhf.2378. Epub 2021 Nov 09.

Navigating between Scylla and Charybdis: challenges and strategies for implementing guideline-directed medical treatment in heart failure with reduced ejection fraction.

European journal of heart failure

Petar M SeferoviĆ, Marija Polovina, Christopher Adlbrecht, Jan BĚlohlávek, Ovidiu Chioncel, Eva Goncalvesová, Ivan MilinkoviĆ, Avishay Grupper, Róbert Halmosi, Ginta Kamzola, Konstantinos C Koskinas, Yuri Lopatin, Alexander Parkhomenko, Pentti Põder, Arsen D RistiĆ, Gintar Šakalyt, Matias TrbušiĆ, Meiramgul Tundybayeva, Bojan Vrtovec, Yoto T Yotov, Davor MiličiĆ, Piotr Ponikowski, Marco Metra, Giuseppe Rosano, Andrew Js Coats

Affiliations

  1. Faculty of Medicine, Belgrade University, Belgrade, Serbia.
  2. Serbian Academy of Sciences and Arts, Belgrade, Serbia.
  3. Department of Cardiology, University Clinical Centre, Belgrade, Serbia.
  4. Imed19-privat, Private clinical research center, Vienna, Austria.
  5. Second Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
  6. University of Medicine Carol Davila, Bucharest, Romania.
  7. Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu'Bucharest, Romania.
  8. Dept Cardiology, Faculty of Medicine, Comenius University and Nat Cardiovasc Inst, Bratislava, Slovakia.
  9. Cardiology division, Sheba Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Israel.
  10. First Department of Medicine, University of Pecs, Medical School, Pecs, Hungary.
  11. Kamzola: Latvian Centre of Cardiology, Pauls Stradins Clinical University hospital, Riga, Latvia.
  12. Department of Cardiology, Bern University Hospital, Bern, Switzerland.
  13. Volgograd State Medical University, Regional Cardiology Centre Volgograd, Volgograd, Russian Federation.
  14. Emergency Cardiology Department. Institute of Cardiology, Kyiv, Ukraine.
  15. First Cardiology Department, North Estonia Medical Centre Foundation, Tallinn, Estonia.
  16. Department of Cardiology, Medical Academy, Faculty of Medicine Lithuanian University of Health Sciences.
  17. University of Zagreb School of Medicine, Zagreb, Croatia.
  18. Department of Cardiology, Kazakh National Medical University, Almaty, Kazakhstan.
  19. Department of Cardiology, UMC Ljubljana, Slovenia.
  20. First Department of Internal Medicine, Medical University of Varna, Varna, Bulgaria.
  21. Second Cardiology Clinic, University Hospital St. Marina, Varna, Bulgaria.
  22. Centre for Heart Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.
  23. Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
  24. RCCS San Raffaele Pisana, Rome, Italy.
  25. University of Warwick, Coventry, UK.

PMID: 34755422 DOI: 10.1002/ejhf.2378

Abstract

Guideline-directed medical therapy (GDMT) has the potential to reduce the risks of mortality and hospitalisation in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, real-world data indicate that many patients with HFrEF do not receive optimised GDMT, which involves several different medications, many of which require up-titration to target doses. There are many challenges to implementing GDMT, the most important being patient-related factors (comorbidities, advanced age, frailty, cognitive impairment, poor adherence, low socioeconomic status), treatment-related factors (intolerance, side-effects) and healthcare-related factors that influence availability and accessibility of HF care. Accordingly, international disparities in resources for HF management and limited public reimbursement of GDMT, coupled with clinical inertia for treatment intensification combine to hinder efforts to provide GDMT. In this review paper, authors aim to provide solutions based on available evidence, practical experience, and expert consensus on how to utilise evolving strategies, novel medications, and patient profiling to allow the more comprehensive uptake of GDMT. Authors discuss professional education, motivation, and training, as well as patient empowerment for self-care as important tools to overcome clinical inertia and boost GDMT implementation. We provide evidence on how multidisciplinary care and institutional accreditation can be successfully used to increase prescription rates and adherence to GDMT. We consider the role of modern technologies in advancing professional and patient education and facilitating patient-provider communication. Finally, authors emphasise the role of novel drugs (especially sodium-glucose cotransporter-2 inhibitors), and a tailored approach to drug management as evolving strategies for the more successful implementation of GDMT. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

Keywords: guideline directed medical therapy; health education; heart failure; medication adherence; optimal treatment; quality of care; sodium-glucose cotransporter-2 inhibitors

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