Rapid Clinical Updates: Heart Failure Implementation Science and Best Clinical Practices-Slides

Slides

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This document is a comprehensive overview of heart failure (HF) implementation science and best clinical practices, presented by several experts including Dr. Lily Ackermann, Dr. Ebrahim Barkoudah, Dr. Safia Chatur, and Dr. Ankeet S. Bhatt. It highlights the gap between evidence-based HF therapies—namely guideline-directed medical therapy (GDMT) including beta blockers, ACE inhibitors/ARNi, SGLT2 inhibitors, and MRAs—and their adoption in clinical practice, noting that only about 5% of patients receive optimal therapy.<br /><br />Key questions focus on managing HF patients with acute changes in renal function, emphasizing the importance of restarting GDMT before discharge once patients are stable. The target timeline for achieving quadruple therapy is suggested to be as early as 4 to 6 weeks post-diagnosis or exacerbation.<br /><br />The presentation emphasizes implementation science, defined as studying strategies that facilitate uptake of evidence-based practices into routine care, aiming to close the “know-do” gap in HF management. Several trials are reviewed, including REVEAL-HF (risk-based audit and feedback), PROMPT-HF (best practice alerts), BETTER-CARE-HF (targeted medication alerts), STRONG-HF (protocolized intensified care), IMPLEMENT-HF (virtual care teams), and transitional care programs like PACT-HF and CONNECT-HF. These interventions vary in intensity, scalability, and impact, addressing both outpatient and hospitalized settings.<br /><br />Special attention is given to patients with HF and chronic kidney disease (CKD), a population with higher risks of cardiovascular and kidney adverse events and historically under-prescribed GDMT. Data from trials like DAPA-HF, DELIVER, and PARADIGM-HF show the safety and efficacy of ARNI and SGLT2 inhibitors across a spectrum of kidney function. Early eGFR declines (“dips”) after therapy initiation are common but not predictive of harm. Current FDA guidance sets renal function thresholds for initiation or continuation of therapies, but ongoing trials aim to better define safety in advanced CKD.<br /><br />Overall, effective HF care requires precise, scalable implementation strategies to optimize GDMT, especially in complex patients with renal impairment, to reduce morbidity and mortality.

Keywords

heart failure

implementation science

guideline-directed medical therapy

beta blockers

ACE inhibitors

ARNi

SGLT2 inhibitors

MRAs

chronic kidney disease

clinical trials