Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May-Jun;39(3):245-254.
doi: 10.1097/JCN.0000000000001051. Epub 2023 Oct 19.

Use of Human-Centered Design Methodology to Develop a Digital Toolkit to Optimize Heart Failure Guideline-Directed Medical Therapy

Erin M Spaulding, Nino Isakadze, Nancy Molello, Shireen R Khoury, Yumin Gao, Lisa Young, Inga M Antonsdottir, Zahra Azizi, Michael P Dorsch, Jessica R Golbus, Ana Ciminelli, Luisa C C Brant, Cheryl R Himmelfarb, Josef Coresh, Francoise A Marvel, Chris T Longenecker, Yvonne Commodore-Mensah, Nisha A Gilotra, Alexander Sandhu, Brahmajee Nallamothu, Seth S Martin

Use of Human-Centered Design Methodology to Develop a Digital Toolkit to Optimize Heart Failure Guideline-Directed Medical Therapy

Erin M Spaulding et al. J Cardiovasc Nurs. 2024 May-Jun.

Abstract

Background: Guideline-directed medical therapies (GDMTs) improve quality of life and health outcomes for patients with heart failure (HF). However, GDMT utilization is suboptimal among patients with HF.

Objective: The aims of this study were to engage key stakeholders in semistructured, virtual human-centered design sessions to identify challenges in GDMT optimization posthospitalization and inform the development of a digital toolkit aimed at optimizing HF GDMTs.

Methods: For the human-centered design sessions, we recruited ( a ) clinicians who care for patients with HF across 3 hospital systems, ( b ) patients with HF with reduced ejection fraction (ejection fraction ≤ 40%) discharged from the hospital within 30 days of enrollment, and ( c ) caregivers. All participants were 18 years or older, English speaking, with Internet access.

Results: A total of 10 clinicians (median age, 37 years [interquartile range, 35-41], 12 years [interquartile range, 10-14] of experience caring for patients with HF, 80% women, 50% White, 50% nurse practitioners) and three patients and one caregiver (median age 57 years [IQR: 53-60], 75% men, 50% Black, 75% married) were included. Five themes emerged from the clinician sessions on challenges to GDMT optimization (eg, barriers to patient buy-in). Six themes on challenges (eg, managing medications), 4 themes on motivators (eg, regaining independence), and 3 themes on facilitators (eg, social support) to HF management arose from the patient and caregiver sessions.

Conclusions: The clinician, patient, and caregiver insights identified through human-centered design will inform a digital toolkit aimed at optimizing HF GDMTs, including a patient-facing smartphone application and clinician dashboard. This digital toolkit will be evaluated in a multicenter, clinical trial.

PubMed Disclaimer

Conflict of interest statement

Under a license agreement between Corrie Health and Johns Hopkins University, the university owns equity in Corrie Health. The university, F.A.M. and S.S.M. are entitled to royalty distributions related to Corrie Health. In addition, F.A.M. and S.S.M. are co-founders of and hold equity in Corrie Health. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. F.A.M. and S.S.M. have also received research and material support from Apple and iHealth. Furthermore, S.S.M. is on the Advisory Board for Care Access and reports personal consulting fees from Amgen, AstraZeneca, Chroma, Kaneka, NewAmsterdam, Novartis, Novo Nordisk, Sanofi, and 89bio. E.M.S. reports personal consulting fees from Corrie Health. A.S. reports consulting fees from Lexicon Pharmaceuticals, Reprieve Cardiovascular, and Cleerly Health. N.A.G. reports consulting fees from Kiniksa Pharmaceuticals. All other authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.. Steps of the Virtual Inclusive Digital Health Intervention Design to Promote Health Equity (iDesign) Framework
This figure was published (and can be reproduced) under the terms of Creative Commons Atrribution 4.0 license.
See this image and copyright information in PMC

References

    1. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2023 update: a report from the American Heart Association [published correction appears in Circulation. 2023 Feb 21;147(8):e622]. Circulation. 2023;147(8):e93–e621. doi:10.1161/CIR.0000000000001123 - DOI - PubMed
    1. Shah KS, Xu H, Matsouaka RA, et al. Heart failure with preserved, borderline, and reduced ejection fraction: 5-year outcomes. J Am Coll Cardiol. 2017;70(20):2476–2486. doi:10.1016/j.jacc.2017.08.074 - DOI - PubMed
    1. Vaduganathan M, Claggett BL, Jhund PS, et al. Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: a comparative analysis of three randomised controlled trials. Lancet. 2020;396(10244):121–128. doi:10.1016/S0140-6736(20)30748-0 - DOI - PubMed
    1. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: executive summary: a report of the american college of cardiology/american heart association joint committee on clinical practice guidelines. Circulation. 2022;145(18):e876–e894. doi:10.1161/CIR.0000000000001062 - DOI - PubMed
    1. Greene SJ, Butler J, Albert NM, et al. Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF registry. J Am Coll Cardiol. 2018;72(4):351–366. doi:10.1016/j.jacc.2018.04.070 - DOI - PubMed

Publication types