Care Of Heart Failure Patients Research Articles

Physiologist-led management of heart failure patients using cardiac implantable electronic device diagnostics during COVID-19: a 2-year UK perspective

Abstract Background/ Introduction The COVID-19 pandemic prompted greater use of remote monitoring capabilities of cardiac implantable electronic devices (CIED). The HeartLogic Index incorporated within certain Boston Scientific CIEDs uses device-derived physiological parameters to generate a score which may be predictive of worsening heart failure (HF). We aimed to define the utility of a novel service, led by cardiac physiologists acting autonomously upon HeartLogic Index alerts, to guide HF patient care during the pandemic. Purpose To assess the utility of a physiologist-led HF service, using CIED diagnostics combined with clinical assessment, to improve HF management. Methods In a single-centre prospective study, 153 Boston Scientific CRT/ICD patients were reviewed over a 2-year period using the integrated HeartLogic algorithm. In response to a HeartLogic alert indicating worsening HF, the patient was contacted by a cardiac physiologist using a structured telephone triage to assess HF symptoms. In those deemed as being at risk of decompensated HF based on clinical assessment, an intervention was made e.g. face-to-face physiologist-led clinical assessment, consultant review, medication optimisation. Results During the 2-year audit, 748 alerts were received from 60 patients, the majority of which had a HF implant indication (n=42). Twenty-one patients within the study population required an intervention due to worsening HF. Following intervention, there were no further hospitalisations within this group. Five hospitalisations were documented during the audit, only 3 of which were HF related. Of these HF hospitalisations, one patient denied HF symptoms at the time of telephone contact, one had a HF decompensation due to deteriorating renal failure and the final patient had a disconnected remote monitor. During the 2-year audit, there were a total of 13 deaths, 3 of which were classified as caused by HF. Conclusion A physiologist-led service may be of clinical utility within this complex patient population, with the audit results demonstrating favourable outcomes with a low rate of mortality and HF hospitalisations. The addition of this service can act to streamline the time from patient presentation to HF review, and therefore improve patient care.

Sleep Apnea and Heart Failure-Current State-of-The-Art.

Sleep-disordered breathing (SDB), including obstructive and central sleep apnea, significantly exacerbates heart failure (HF) through adverse cardiovascular mechanisms. This review aims to synthesize existing literature to clarify the relationship between SDB and HF, focusing on the pathophysiological mechanisms, diagnostic challenges, and the effectiveness of treatment modalities like continuous positive airway pressure (CPAP) and adaptive servo-ventilation ASV. We analyzed peer-reviewed articles from 2003 to 2024 sourced from PubMed, EMBASE, Scopus, and Web of Science databases. The prevalence of SDB in HF patients is high, often underdiagnosed, and underappreciated. Management strategies, including CPAP and ASV, have been shown to mitigate symptoms and improve cardiac function. However, despite the availability of effective treatments, significant challenges in screening and diagnosis persist, affecting patient management and outcomes. DB significantly impacts HF prognosis. Enhanced screening strategies and broader utilization of therapeutic interventions like CPAP and ASV are essential to improve the management and outcomes of HF patients with concomitant SDB. Future research should focus on refining diagnostic and treatment protocols to optimize care for HF patients with SDB.

The IN-HF Registry: the history and the scientific production for the Italian cardiology community

The Italian Network on Congestive Heart Failure (IN-CHF) project, later known as IN-HF Online, was launched in 1995 to provide the Italian cardiology community with a digital tool, standardized across the country, for managing outpatients with heart failure (HF), that enabled the creation of a database for clinical, educational and scientific purposes. During its almost three decades of activity, this observational research program has achieved highly positive scientific results. Indeed, IN-HF fostered professional relationships among individuals working in different centers, established a cultural network for the care of HF patients, periodically updated on the scientific advances, and allowed the assessment of several clinical, epidemiological, and prognostic features. These findings have been published in numerous national and international journals, as summarized in the present overview.

Heart failure clinic inclusion and exclusion criteria: cross-sectional study of clinic’s and referring provider’s perspectives

ObjectivesThere are substantial variations in entry criteria for heart failure (HF) clinics, leading to variations in whom providers refer for these life-saving services. This study investigated actual versus ideal HF...

Sex Differences in Cardiac and Clinical Phenotypes and Their Relation to Outcomes in Patients with Heart Failure.

Biological sex is one of the major factors characterizing the heart failure (HF) patient phenotype. Understanding sex-related differences in HF is crucial to implement personalized care for HF patients with various phenotypes. There are sex differences in left ventricular (LV) remodeling patterns in the HF setting, namely, more likely concentric remodeling and diastolic dysfunction in women and eccentric remodeling and systolic dysfunction in men. Recently supra-normal EF (snLVEF) has been recognized as a risk of worse outcome. This pathology might be more relevant in female patients. The possible mechanism may be through coronary microvascular dysfunction and sympathetic nerve overactivation from the findings of previous studies. Further, estrogen deficit might play a significant role in this pathophysiology. The sex difference in body composition may also be related to the difference in LV remodeling and outcome. Lower implementation in guideline-directed medical therapy (GDMT) in female HFrEF patients might also be one of the factors related to sex differences in relation to outcomes. In this review, we will discuss the sex differences in cardiac and clinical phenotypes and their relation to outcomes in HF patients and further discuss how to provide appropriate treatment strategies for female patients.

Unmet needs in end-of-life care for heart failure patients

ObjectiveTo investigate end-of-life (EoL) care for heart failure (HF) in Tuscany (Italy) from healthcare professionals' perspective and identify areas for intervention. MethodsAll the directors of Cardiology units (n = 29) and palliative care (PC) units (n = 14) in Tuscany were surveyed on the practices of EoL care. ResultsForty-five percent of cardiologists reported that their hospital had some EoL care services for HF patients. However, 75% did not have a multidisciplinary team providing EoL care for HF patients. Sixty-four percent stated that <25% of patients who might benefit from PC did receive it, and 18% stated that no patient received PC. For most of PC specialists, HF patients accounted for <25% of their patients. PC specialists believed that patients with cancer diseases were much more likely to receive PC than HF patients at EoL, and 36% judged that almost no HF patients were timely referred to hospice care. The majority of PC specialists reported that almost no HF patient prepared advance healthcare directives, as opposite to 57% for cancer patients, suggesting poor understanding or acceptance of their terminal condition. ConclusionsThe management of HF patients in the EoL stage in Tuscany is often suboptimal. EoL care should be implemented to ensure an adequate quality of life to these patients.

Experiences on health-related quality of life of Jordanian patients living with heart failure: A qualitative study.

Quantitative studies have provided valuable statistical insights into Health-Related Quality of Life (HRQoL) among patients with Heart Failure (HF), yet they often lack the depth to fully capture the nuanced, subjective experiences of living with HF particularly in the specific context of Jordan. This study explores the personal narratives of HF patients to understand the full impact of HF on their daily lives, revealing HRQoL aspects that quantitative metrics often miss. This is crucial in developing regions, where the increasing prevalence of HF intersects with local healthcare practices, cultural views, and patient expectations, providing key insights for tailored interventions and better patient care. Utilizing a phenomenological qualitative design, this study conducted face-to-face semi-structured interviews with 25 HF patients to deeply explore their lived experiences. Thematic analysis was employed to identify major themes related to their perceptions of HF as a disease, its impact on various HRQoL domains, and their recommended strategies to enhance HRQoL. The study involved 25 participants (13 males, 12 females), aged 26-88 years (mean 63), with diverse education and heart failure (HF) severities. It revealed three themes: HF perceptions, its impact on health-related quality of life (HRQoL) across physical, psychosocial, spiritual, cognitive, and economic domains, and HRQoL improvement strategies. Participants had varied HF knowledge; some lacked basic understanding. The physical impact was most significant, affecting daily life and causing symptoms like breathing difficulties, coughing, edema, and fatigue. This physical aspect influenced their psychosocial and spiritual lives, cognitive functions, and economic stability, leading to fear, frustration, worry, social isolation, spiritual and cognitive challenges, and employment problems. The results underscores the need for holistic healthcare approaches, integrating medical, psychological, and social support. Key recommendations include integrated care models, comprehensive patient education, support networks, and policy interventions to enhance HF patient care.

Reducing the hospitalization epidemic of chronic heart failure by disease management programs.

Chronic heart failure is the most common cause of hospitalization in Europe and rates are steadily increasing due to aging of the population. Hospitalization identifies a fundamental change in the natural history of heart failure (HF) increasing the risk of re-hospitalization and mortality. Heart failure management programs improve the quality of care for HF patients and reduce hospitalization burden. The goals of the heart failure management programs include optimization of drug therapy, patient education, early recognition of signs of decompensation, and management of comorbidities. Randomized clinical trials evidenced that system of care for heart failure patients improved adherence to treatment and reduced unplanned re-admissions to hospital. Multidisciplinary programs and home-visiting have shown improved efficacy with reductions in HF and all-cause hospitalizations and mortality. Community HF clinics should take care of the management of stable patients in strict contact with primary care, while hospital out-patients clinics should care of patients with severe disease or persistent clinical instability, candidates to advanced treatment options. In any case a holistic, patient-centered approach is suggested, to optimize care considering the needs of the individual patient. Telemonitoring is a new opportunity for HF patients, because it allows the continuity of care at home. All heart failure patients should require follow-up in a specific management program, but most of date come from clinical trials that included high-risk patients. While clinical trials have a specified duration (from months to some years), lifelong follow-up is recommended with differentiated approaches according to the patient's need.

The State and Direction of Treatment of Heart Failure with Reduced Ejection Fraction in Papua New Guinea

The pharmacological treatment of heart failure has evolved over the last three decades since the demonstration of the effect of angiotensin-converting enzyme inhibitors on major cardiovascular events in patients with heart failure with reduced ejection fraction. Composite analysis of heart failure with reduced ejection fraction trials and the recent identification of newer drug treatments show early benefits on the major cardiovascular outcomes, ushering in a change of the treatment strategy; from a ‘sequential’ initiation of the treatments to a ‘simultaneous’ initiation to harness the early benefits. The adoption and implementation of these changes at the bedside have been dismal in many healthcare settings. Papua New Guinea, like many other lower-to-middle-income countries, is facing many barriers that impact on the care of heart failure patients. It needs to adopt and implement these changes to provide evidence-based treatment for its people with heart failure with reduced ejection fraction.

Dapagliflozin: a potential lifesaver for “heart failure patients with mildly reduced or preserved ejection fraction” in the world

Dear Editor, According to the "World Health Organization (WHO)," approximately 17.9 million people die each year from cardiovascular diseases like heart failure, making it the second-leading cause of death in the world after cancer. (1) Consequently, treatment and care for heart failure patients have been significant concerns among medical professionals for years. Despite the numbers, Pakistan still lacks the primary resources to support heart failure patients. According to the data on the heart attack ratio for 2020, approximately 240,720 people died from heart failure and coronary artery disease (CAD) in Pakistan, accounting for around 16 percent of all fatalities. (2) However, Dapagliflozin, a sodium-glucose transporter inhibitor (SGLTi), along with a healthy diet, exercise, and other medications, improves glycemic control in adults with type 2 diabetes and also reduces the risk of hospitalization for heart failure among adults with type 2 diabetes.(3) In a study published in JAMA Cardiology in 2023, Jhund PS et al. examined the relationship between Dapagliflozin and heart failure and discovered a reduction of the rate of total HF events in patients with mildly reduced or preserved ejection fraction and cardiovascular deaths in the Dapagliflozin group by 3.5 events as compared to the placebo group. (4) Additionally, Scott Solomon et al. indicated that Dapagliflozin reduced the combined risk of worsening heart failure or cardiovascular death among patients with heart failure with reduced or preserved ejection fraction by 3.1% in the Dapagliflozin group as compared to the placebo group. (5) These satisfying statistics indicate that Dapagliflozin is the world's potential lifesaver for heart failure patients with mildly reduced or preserved ejection fraction. In order to ensure the safety of heart failure patients, it is imperative to promote and scale up the research, production, and availability of the drug Dapagliflozin in our healthcare systems and pharmacies on a large scale in Pakistan, particularly in rural and remote areas.

Impact of a structured educational intervention on attitudes and clinical practices in heart failure among physicians in argentina

Abstract Introduction It is necessary to identify areas for improvement in the care of patients with heart failure (HF), and thus implement educational interventions to optimize the quality of care and their clinical outcomes. Objective The aim of this study was to evaluate the attitudes, knowledge, confidence and care pathways of patients with HF among physicians in Argentina and their subsequent changes after an educational intervention. Methods We conducted a cross-sectional study using a self-administered survey to evaluate clinical practice patterns and attitudes/perceptions regarding the diagnosis, treatment and follow-up of HF patients in the outpatient and inpatient settings. Survey respondents were physicians from 22 centers in Argentina who participated in a comprehensive educational programme for the care of HF patients conducted between March and July 2021. The educational intervention was based on a 30-hour training programme in heart failure clinics and a final examination. Simple road maps were created to address the knowledge gaps identified in the pre-intervention phase. Results A total of 50 physicians were surveyed; the mean age was 41±8 years and 86% were cardiologists. The educational intervention significantly increased physicians' confidence in diagnosing HFpEF, with 52% feeling "confident" or "very confident" before and 84% after the intervention (p&amp;lt;0.001). In outpatients with HFrEF, more physicians reported prioritizing quadruple therapy with SLGT-2i, mineralocorticoid receptor antagonists (MRA), beta-blockers and angiotensin receptor neprilysin inhibitors (ARNI) in the post-intervention period (p&amp;lt;0.05, figure 2). No differences were found in the reported time to optimal medical treatment (p=0.7). After the intervention, the proportion of physicians who felt "confident" or "very confident" in identifying patients who could benefit from an implantable cardioverter-defibrillator increased from 70% to 96% (p=0.01). After the intervention, more doctors considered "relevant" and "very relevant" the administration of hypertonic saline (22% to 52%; p=0.01), and intravenous iron (56% to 80%; p=0.041). Compared to the pre-intervention period, more physicians prioritized quadruple therapy with beta-blockers, MRA, ARNI and SGLT2i (p&amp;lt;0.05, figure 2) at hospital discharge. There was a significant increase in the use of the discharge checklist from 26% to 48% (p=0.05). Conclusions A multifaceted structured educational intervention was effective in improving knowledge and attitudes about the diagnosis and management of patients with HF among physicians in Argentina. The results of the present study demonstrate that an educational intervention can increase knowledge and improve clinical attitudes in the diagnosis of HFpEF and management of outpatients and hospitalized patients with HFrEF. Further studies are needed to determine the impact of such programmes in other countries.

Self-monitoring using Mobile App to improve symptoms and Reduce rehospitalization and morTality in Heart Failure (SMART-HF trial)i

Abstract Background Considering the uncertainty of the benefits of mobile apps in patients with heart failure (HF), we developed a mobile health platform and aimed to evaluate this intervention in terms of improving symptoms and outcomes in HF. Methods Seven tertiary hospitals in South Korea participated in this prospective, randomized, open-label, nationwide, multicenter, pilot trial (SMART-HF trial). Patients aged ≥20 years hospitalized for acute heart failure who were able to use a smartphone were enrolled before discharge. Eligible participants were then randomized 1:1 to either the intervention group (AIDA/KT-app with devices) or the control group (AIDA/KT-app only). The mobile health platform consists of three parts: 1) smartphone app for patients (2) dashboard system for physicians (3) clinical decision support system. Only in the intervention group, the applications were automatically paired with a Bluetooth blood pressure monitor, weight scale and body water analyzer. The intervention group were able to enter their HF symptom scale into the app and receive feedback or alerts on their input. In the control group, patients could only enter their blood pressure, weight, and HF symptom into the app, and there are no connected devices and no feedback from the app. Results 84 patients were randomized to the intervention group (n=43) and control group (n=41). Overall, 62.8% of the patients were male, and the median age was 63.0 years. At 4 weeks, dyspnea score by questionnaire (range 0-10) was 1.5±2.3, and 2.0±2.4 in the intervention and control groups, respectively, and was not significantly different (P=0.415). The total HF symptom score (range 0-12) including dyspnea, fatigue, edema, and palpitation entered by the participants in the apps was not significantly different between two groups (2.0±2.1, and 1.6±2.1, P=0.454). In the intervention group, the level of body water composition showed trend toward decreasing during study period (initial level 7.46 -&amp;gt; final level 6.71, P=0.10). App adherence during the study period was higher in the intervention group compared with control group (70.6±32.5% vs. 47.8±32.0%, P=0.004). App satisfaction scores tended to be higher in the intervention group (7.1±2.6 vs. 6.2±2.9, P=0.147). Secondary composite endpoints including death, rehospitalization, and urgent HF visit were not significantly different between two groups (4/40 vs. 3/38, P=0.999). Conclusions Our mobile health platform showed feasibility and efficacy for HF patients although clinical outcomes were not significantly different, maybe due to small sample size. Considering that motivating patients to use the mHealth tool more frequently may lead to greater clinical benefit, further large research with a positive user experience is needed for HF patient care.

Abstract 14740: Identifying Predictors of Timing to Guideline-Directed Medical Therapy for Medical Beneficiaries With Heart Failure

Introduction: Despite substantial evidence supporting the timely initiation and optimization of guideline-directed medical therapy (GDMT) for patients with heart failure, its utilization remains low. Hypothesis: Variation in GDMT prescribing will be explained by patient-, clinician-, and hospital-level determinants that can serve as targets for future interventions. Methods: This study included 793,319 fee-for-service Medicare beneficiaries admitted with heart failure (incident or acute-on-chronic) between 2009-17. The GDMT outcome was the receipt of 1 from each of 3 medication classes within 120 days of discharge: beta blockers, ACE inhibitors/ARBs, or MRAs. Candidate predictors included patient demographics, pre-admission medication, community distress (social determinants), and Charlson comorbidities. Models, estimated via logistic regression and marginal effects, considered unobserved changes in practice patterns over time and, in some specifications, provider differences (fixed effects). Other specifications controlled for observed hospital characteristics. Results: The cohort was 49% female (n=390,765), 16% Black (n=123,238), 6% Hispanic (n=50,138) with a median (IQR) of 78 years (69-86). The median number of comorbidities was 3 (IQR 2-4). The overall 120-day use of beta blockers was 55%, ACE inhibitors/ARBs 47%, MRAs 21%, and all three medications 11%. After adjustment, the largest predictors of GDMT were pre-admission medication use and comorbidities (eg, renal disease). Women achieved 0.9% lower GDMT (Figure). Community distress was associated with lower GDMT; yet, the magnitude of effect was small (-0.01%). Academic hospitals achieved 0.3% better GDMT despite having a more severe patient population. Conclusions: GDMT use was low (and lowest for MRAs). Targeted interventions to address these identified predictors may advance the prescribing and use of guideline-directed, evidence-based care for heart failure patients.

Abstract 14113: Impact of Clinician Telemedicine Use on Diagnostic Testing for Heart Failure Patients

Introduction: Previous studies have reported decreased diagnostic testing with telemedicine visits early in the COVID-19 pandemic. The effect of telemedicine use on diagnostic testing for a panel of heart failure (HF) patients is unknown. We sought to use clinician-level variation in telemedicine use over time to determine the association of telemedicine care delivery with changes in diagnostic testing for HF patients. Methods: Patients with HF diagnostic codes seen at an academic cardiovascular center from May 2019 to Nov 2022 were included. Clinicians performing the majority of cardiology visits for at least 10 HF patients were identified. Early pandemic visits (March 2020-May 2020) were excluded. The remaining time was divided into 4 10-month periods with the first ending before the pandemic. We used a linear regression model with clinician and period fixed effects to estimate the association of the fraction of a clinician’s visits delivered by telemedicine in each period with the number of orders for Holter monitors, EKGs, transthoracic echocardiograms (TTEs), and laboratory tests per visit. Results: There were 6,420 patients seen by 45 clinicians. Clinician telemedicine fraction across periods ranged from 0 to 100 percent. Mean telemedicine fraction decreased from 55.4% to 34.6% from periods 2 to 4. A 25-percentage point increase in telemedicine use was associated with significantly fewer orders for EKGs (-0.078 orders/visit) and TTEs (-0.021 orders/visit), representing decreases of 33% and 13% relative to period 1 respectively. Higher telemedicine use was associated with non-significant decreases in orders for Holter monitors and laboratory tests (Table). Conclusions: Greater clinician telemedicine use was associated with decreased diagnostic testing orders per visit for HF patients. Further research is needed to characterize the value of these potentially avoided tests and understand the impact of telemedicine on the quality of care for HF patients.

Chronic care for heart failure patients: Who to refer back to the general practitioner?-Experiences of the Dutch integrated heart failure care model.

The number of patients with heart failure (HF) and corresponding burden of the healthcare system will increase significantly. The Dutch integrated model, 'Transmural care of HF Patients' was based on the European Society of Cardiology (ESC)guidelines and initiated to manage the increasing prevalence of HF patients in primary and secondary care and stimulate integrated care. It is unknown how many HF patients are eligible for back-referral to general practitioners (GPs), which is important information for the management of chronic HF care. This study aims to evaluate clinical practice of patients for whom chronic HF care can be referred from the cardiologist to the GP based on the aforementioned chronic HF care model. A retrospective case record-based study was conducted, which included all chronic HFpatients registered in the cardiology information systems of two different hospitals. Subsequently, 200 patients were randomly selected for evaluation. The following patients were considered eligible for referral to the GP: 1/Stable HF patients with reduced left ventricular ejection fraction (LVEF), 2/Stable HF patients with a recovered LVEF and 3/Stable HF patients with a preserved LVEF, 4/HF, palliative setting. Of the 200 patients, 17% was considered eligible for referral to the GP. This group consisted of 5% patients with a reduced LVEF, 10.5% patients with recovered LVEF and 1.5% patients with a preserved LVEF. Main indicators for HF care by cardiologists wereactive cardiac disease other than HF (39.5%), recent admission for HF (29.5%) or a recent adjustment in HF medication (7.5%). Applying the chronic HF care model of the 'Transmural care of HF patients' and the ESC-guidelines, results in an important opportunity to further optimise HF integrated care and to deal with the increasing number of HF patients referred to the hospital.

Transitional Care in Patients with Heart Failure: A Concept Analysis Using Rogers' Evolutionary Approach.

The purpose of this study was to clarify the concept of transitional care in patients with heart failure. Transitional care is increasingly being applied in patients with heart failure, but the concept of transitional care in heart failure patients is not uniform and confused with other definitions, which limits further research and practice on transitional care for these patients. Rodgers' evolutionary concept analysis. A comprehensive literature search was conducted using the PUBMED, EMBASE, EBSCO, Chinese Biological Medicine (CBM), CNKI, and WANFANG databases (up to January 26, 2023). We used Rodgers' evolutionary concept analysis method to identify related concepts, attributes, antecedents, and consequences of transitional care in patients with heart failure. A total of 33 articles were included. The following attributes belonging to transitional care in patients with heart failure were extracted from the literature: self-care, multidisciplinary collaboration, and information transmission. The antecedents were patients' health status, the health literacy of patients and caregivers, the role functions of the main implementer and social and medical resources. Consequences were separated into two categories: patient-centered health outcomes (all-cause mortality, health-related quality of life, discharge preparedness, self-care behaviors, satisfaction of patients) and healthcare utilization outcomes (hospital readmission, length of hospital stay, emergency department visits). This study found that transitional care in heart failure patients is a systemic care process during a vulnerable period that improves patient self-management and coordination between hospital resources and social support systems for continuous management to promote smooth patient transitions between different locations. This concept analysis will inform healthcare providers in designing evidence-based interventions and quality improvement strategies to ensure that transition processes lead to desired outcomes. In addition, this study will also be helpful for developing specific assessment tools to identify patients with HF who need transitional care.

Telemedicine in Heart Failure in the COVID-19 and Post-Pandemic Era: What Have We Learned?

Numerous studies showed that patients with heart failure (HF) and COVID-19 are at high risk of in-hospital complications and long-term mortality. Changes in the organisation of the medical system during the pandemic also worsened access to standard procedures, increasing the general mortality in HF and forcing the systems to be reorganised with the implementation and development of telemedical technologies. The main challenges for HF patients during the pandemic could be solved with new technologies aimed to limit the risk of SARS-CoV-2 transmission, optimise and titrate the therapy, prevent the progression and worsening of HF, and monitor patients with acute HF events in the course of and after COVID-19. Dedicated platforms, phone calls or video conferencing and consultation, and remote non-invasive and invasive cardiac monitoring became potential tools used to meet the aforementioned challenges. These solutions showed to be effective in the model of care for patients with HF and undoubtedly will be developed after the experience of the pandemic. However, the multitude of possibilities requires central coordination and collaboration between institutes with data protection and cost reimbursement to create effective mechanisms in HF management. It is crucial that lessons be learned from the pandemic experience to improve the quality of care for HF patients.

Electronic Health Record Embedded Strategies for Improving Care of Patients With Heart Failure.

A majority of clinical decisions use the electronic health record (EHR) and there is an unmet need to use its capability to help providers to make evidence-based decisions that improve care for heart failure patients. These electronic nudges are rooted in the human psychology of decision-making and often target specific cognitive biases. This review outlines the development of novel EHR nudges and specific lessons learned from each experience to inform the development of future interventions. There have been several randomized clinical trials examining the impact of EHR alerts on quality of care for heart failure patients. These interventions have targeted both clinicians and patients. There are features of each trial that inform best practices and future directions for EHR nudges. Recent clinical trials have demonstrated that some EHR alerts can improve care for heart failure patients. These trials utilized default options, involved clinicians in the alert design process, provided actionable recommendations, and aimed to minimize disruptions to typical workflow. Alerts aimed at improving care should be examined in a randomized fashion in order to evaluate their impact on clinician satisfaction and patient care.

Broadening Heart Failure Care Beyond Cardiology: Challenges and Successes Within the Landscape of Multidisciplinary Heart Failure Care.

Heart failure (HF) is a growing public health concern that impairs the quality of life and is associated with significant mortality. As the prevalence of heart failure increases, multidisciplinary care is essential to provide comprehensive care to individuals. The challenges of implementing an effective multidisciplinary care team can be daunting. Effective multidisciplinary care begins at the initial diagnosis of heart failure. The transition of care from the inpatient to the outpatient setting is critically important. The use of home visits, case management, and multidisciplinary clinics has been shown to decrease mortality and heart failure hospitalizations, and major society guidelines endorse multidisciplinary care for heart failure patients. Expanding heart failure care beyond cardiology entails incorporating primary care, advanced practice providers, and other disciplines. Patient education and self-management are fundamental to multidisciplinary care, as is a holistic approach to effectively address comorbid conditions. Ongoing challenges include navigating social disparities within heart failure care and limiting the economic burden of the disease.

Relationships and Activities. The study is supported by OOO AstraZeneca Phar­maceuticals.

Heart failure (HF) is a global health problem. Despite advances in the development of effective treatments for patients with heart failure, morbidity and mortality from remain high, and the prognosis is poor. However, there is potential to improve outcomes in HF patients with current disease-modifying therapy. Planning needs and resources, assessing the effectiveness of care for HF patients in clinical practice requires high-quality epidemiological data. Previously performed Russian observational studies of HF were characterized by relatively small sample sizes, inclusion of patients in only one or a few regions, strict selection criteria, single-stage design, or short follow-up. The rationale and design of the all-Russian prospective observational multicenter registry study "PRIORITET-CHF", which included 20000 patients with HF throughout the Russian Federation, is presented. The main aims of the study are to (1) describe baseline clinical and demographic characteristics in outpatients with HF in the Russian Federation and (2) characterize routine therapy and evaluate the compliance of treatment for HF with reduced ejection fraction with current clinical guidelines.