How to tackle therapeutic inertia in heart failure with reduced ejection fraction. A scientific statement of the Heart Failure Association of the ESC
Savarese G. Lindberg F. Cannata A. Chioncel O. Stolfo D. Musella F. Tomasoni D. Abdelhamid M. Banerjee D. Bayes-Genis A. Berthelot E. Braunschweig F. Coats A.J.S. Girerd N. Jankowska E.A. Hill L. Lainscak M. Lopatin Y. Lund L.H. Maggioni A.P. Moura B. Rakisheva A. Ray R. Seferovic P.M. Skouri H. Vitale C. Volterrani M. Metra M. Rosano G.M.C.
June 2024John Wiley and Sons Ltd
European Journal of Heart Failure
2024#26Issue 61278 - 1297 pp.
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.
Clinical inertia , Guideline-directed medical therapy , Heart failure , Heart failure with reduced ejection fraction , Implementation
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Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
School of Cardiovascular Medicine & Sciences, Kings College London British Heart Foundation Centre of Excellence, London, United Kingdom
Department of Cardiology, Kings College Hospital NHS Foundation Trust, London, United Kingdom
Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’, and University of Medicine Carol Davila, Bucharest, Romania
Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
Cardiology Department, Santa Maria delle Grazie Hospital, Naples, Italy
ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
Faculty of Medicine, Kasr Al Ainy, Department of Cardiology, Cairo University, Cairo, Egypt
Renal and Transplantation Unit, St Georges University Hospitals NHS Foundation Trust, Cardiovascular and Genetics Research Institute, St Georges University, London, United Kingdom
Heart Institute, Hospital Universitari Germans Trias I Pujol, CIBERCV, Badalona, Spain
AP-HP, Service de Cardiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
Heart Research Institute, Sydney, NSW, Australia
Centre dInvestigation Clinique Plurithémathique Pierre Drouin & Département de Cardiologie Institut Lorrain du Cœur et des Vaisseaux, Université de Lorraine, CHRU-Nancy, Vandœuvre-lès-Nancy, France
Institute of Heart Diseases, Wroclaw Medical University and Institute of Heart Diseases, University Hospital, Wroclaw, Poland
School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Volgograd State Medical University, Regional Cardiology Centre, Volgograd, Russian Federation
ANMCO Research Center, Heart Care Foundation, Florence, Italy
Armed Forces Hospital, Faculty of Medicine of University of Porto, Porto, Portugal
City Cardiology Center, Konaev City Hospital, Almaty Region, Kazakhstan
Department of Cardiology, St Georges University Hospital, London, United Kingdom
University Medical Center, Medical Faculty University of Belgrade, Serbian Academy of Sciences and Arts, Belgrade, Serbia
Cardiology Division, Internal Medicine Department, Balamand University School of Medicine, Beirut, Lebanon
Department of Exercise Science and Medicine, San Raffaele Open University of Rome, Rome, Italy
Cardiopulmonary Department, IRCCS San Raffaele Roma, Rome, Italy
Cardiology, San Raffaele Hospital, Cassino, Italy
Division of Cardiology
Heart and Vascular Center
School of Cardiovascular Medicine & Sciences
Department of Cardiology
Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’
Division of Cardiology
Cardiology Department
ASST Spedali Civili and Department of Medical and Surgical Specialties
Faculty of Medicine
Renal and Transplantation Unit
Heart Institute
AP-HP
Heart Research Institute
Centre dInvestigation Clinique Plurithémathique Pierre Drouin & Département de Cardiologie Institut Lorrain du Cœur et des Vaisseaux
Institute of Heart Diseases
School of Nursing and Midwifery
Faculty of Medicine
Volgograd State Medical University
ANMCO Research Center
Armed Forces Hospital
City Cardiology Center
Department of Cardiology
University Medical Center
Cardiology Division
Department of Exercise Science and Medicine
Cardiopulmonary Department
Cardiology
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