Optimizing outcomes in heart failure: 2022 and beyond

Abstract

Although the development of therapies and tools for the improved management of heart failure (HF) continues apace, day-to-day management in clinical practice is often far from ideal. A Cardiovascular Round Table workshop was convened by the European Society of Cardiology (ESC) to identify barriers to the optimal implementation of therapies and guidelines and to consider mitigation strategies to improve patient outcomes in the future. Key challenges identified included the complexity of HF itself and its treatment, financial constraints and the perception of HF treatments as costly, failure to meet the needs of patients, suboptimal outpatient management, and the fragmented nature of healthcare systems. It was discussed that ongoing initiatives may help to address some of these barriers, such as changes incorporated into the 2021 ESC HF guideline, ESC Heart Failure Association quality indicators, quality improvement registries (e.g. EuroHeart), new ESC guidelines for patients, and the universal definition of HF. Additional priority action points discussed to promote further improvements included revised definitions of HF 'phenotypes' based on trial data, the development of implementation strategies, improved affordability, greater regulator/payer involvement, increased patient education, further development of patient-reported outcomes, better incorporation of guidelines into primary care systems, and targeted education for primary care practitioners. Finally, it was concluded that overarching changes are needed to improve current HF care models, such as the development of a standardized pathway, with a common adaptable digital backbone, decision-making support, and data integration, to ensure that the model 'learns' as the management of HF continues to evolve.

Keywords: Clinical practice guidelines; Health technology assessment; Heart failure; Medical decision making; Multidisciplinary management; Pharmacotherapy; Quality improvement.

Figure 1

Key challenges to the optimal management of heart failure.

Figure 2

Summary of identified barriers, mitigation strategies, and priority action points. Mitigation strategies in green are recent or ongoing developments. Mitigation strategies in orange as proposed for future implementation. EMR, electronic medical record; ESC, European Society of Cardiology; HCP, healthcare professional; HF, heart failure; HFA, Heart Failure Association; PCP, primary care physician; PRO, patient‐reported outcome; QIs, quality indicators; UDHF, universal definition of heart failure.