An Electronically Delivered, Patient-activation Tool for Intensification of Chronic Medications for Heart Failure with Reduced Ejection Fraction: The Epic-hf Trial

Abstract

Introduction Guideline Directed Medical Therapy (GDMT) recommends a combined regimen of beta blockers, ACE-I/ARB/ARNI, and mineralocorticoid receptor agents for optimal treatment of patients with Heart Failure with Reduced Ejection Fraction (HFrEF). Unfortunately, data from numerous heart failure registries show that HFrEF patients by-and-large continue to remain on suboptimal therapy. Interventions to improve medication plans often target either patient adherence or provider prescribing methods, with mixed results. This suggests that a more novel approach—in which provider and patient are equally involved—may be necessary to incite change. Hypothesis Aspects of Direct-to-Consumer (DTC) methods and Shared Decision Making models can be harnessed to encourage patients to engage providers in HFrEF prescribing decisions. This in turn may improve use of guideline-directed medical therapies. Methods Using DTC and Shared Decision Making models as our framework (Figure 1), we developed a user-friendly patient activation intervention—a 3-minute video and a HFrEF medication checklist—to encourage patients to discuss with their provider “one thing” that can be done to improve their medication plan. Patients were enrolled across three medical centers within the UCHealth medical system, and randomized to either intervention or control arms. Data on HFrEF medication prescribing and dosing was collected at enrollment, at time of intervention, and at 1-and-6 months from intervention. Results 305 patients were enrolled in total. At time of enrollment, 8.5% were on GDMT at suboptimal doses; only one patient (.3%) was on GDMT at target doses. Conclusions Our baseline results highlight the clear need for effective interventions to improve HFrEF prescribing. If successful, our intervention is simple enough to be adapted and implemented across a multitude of settings.