Low familiarity of guideline-directed heart failure care among patients

1. In this survey of patients with heart failure, most participants were familiar with angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), beta-blockers and diuretics. Fewer patients reported familiarity with angiotensin receptor–neprilysin inhibitors or mineralocorticoid receptor antagonists.

2. Patients commonly reported concerns with regards to the safety profile and effectiveness of medications included in guideline-directed therapy.

Evidence Rating Level: 3 (Average)       

Study Rundown: Heart failure is a common chronic medical condition with significant mortality, morbidity, and reduction in quality of life. Use of pharmacologic strategies have led to reductions in heart failure symptoms, hospital admissions, and improved mortality. Guidelines suggesting the optimal combination therapies and adequate dosing of these medications are often not followed. The current study sought to evaluate the pharmacotherapy knowledge of patients with chronic heart failure, to explore if this may affect the likelihood of adhering to guideline-directed medical therapy (GDMT). The study found that most patients were familiar with beta-blockers, diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and less commonly knowledgeable of angiotensin receptor–neprilysin inhibitors or mineralocorticoid receptor antagonists. Many patients reported concerns with regards to efficacy and safety profiles of these medications.

The current study highlights the importance of patient education and the need to further inform patients on the options and evidence for GDMT. The main strength of the study is the large contemporary cohort of heart failure patients exploring patient values and perceptions of therapy. The main weaknesses of the study is selection bias for participants with fairly high education levels, and lack of patient knowledge over factors that may influence therapy choice (such as ejection fraction).

Click to read the study in JAMA Cardiology

Relevant Reading: Patient activation, knowledge, and health literacy association with self-management behaviors in persons with heart failure

In-Depth [survey]: This study used data from the GfK Knowledge Panel, a probability-based online panel designed to be representative of the noninstitutionalized civilian American population. Participants were included if they were 18 years or older, self-reported a heart failure diagnosis, and were taking heart failure medications. Patients with a left-ventricular assist device or heart transplant were excluded. Data was collected from October to November 2018.

The study included 429 participants who completed the survey, with most (409 [95.3%]) having at least a high school education. Most respondents were familiar with beta-blockers (354[82.5%]), ACE-I or ARB (322 [75.2%]), and diuretics (339 [79.1%]); while fewer knew about angiotensin receptor–neprilysin inhibitors (105 [24.6%]) and mineralocorticoid receptor antagonists 94 (22.4%). Patients frequently reported concerns of safety (36.5-41.5%) and efficacy (27.7%-41%).

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