Lauren G Gilstrap1, David Snipelisky2, Omar AbouEzzeddine2, Justin Vader3, Lauren Cooper4, Jacob Kelley5, Antonio Perez6, Kenneth Varian6, Anuradha Lala7, Monica Shah8, Lynne W Stevenson9. 1. Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: lgilstrap@bwh.harvard.edu. 2. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. 3. Cardiovascular Division, Washington University, St Louis, Missouri. 4. Inova Heart & Vascular Institute, Falls Church, Virginia; Division of Cardiology, Duke University, Durham, North Carolina. 5. Division of Cardiology, Duke University, Durham, North Carolina. 6. Section of Advanced Heart Failure and Transplant Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 7. Division of Cardiology, Mount Sinai Hospital, New York, New York. 8. National Heart, Lung, and Blood Institute, Bethesda, Maryland. 9. Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Abstract
OBJECTIVE: The epidemiology of heart failure (HF) is changing. This study aimed to describe questions that arise during the routine care of HF patients that are unanswered by the current literature and describe how the type and focus of these questions has changed over time. METHODS: Investigators from the National Heart, Lung, and Blood Institute-sponsored Heart Failure Apprentice Network collected and categorized questions from 5 academic hospitals over 12 months. A total of 174 unanswered questions were collected and analyzed. RESULTS: Compared with 2004, there were more unanswered questions about "whether" to use therapies and fewer about "how" to use therapies. There were fewer questions about what therapeutic targets, therapy adjustment, and combination therapies. There were more questions about whether or how to stop therapies and how to add therapies back. Newly prominent topics, not observed in 2004, including novel therapeutics, refractory ventricular tachycardia, right heart failure, and nutrition/frailty, accounted for 24% of questions. CONCLUSIONS: Compared with 2004, there are fewer unanswered questions about how to use, adjust, and combine therapies. There were more unanswered questions about whether and how to stop therapies. Almost 25% of unanswered questions dealt with topics indicative of more advanced disease which were not observed in 2004.
OBJECTIVE: The epidemiology of heart failure (HF) is changing. This study aimed to describe questions that arise during the routine care of HF patients that are unanswered by the current literature and describe how the type and focus of these questions has changed over time. METHODS: Investigators from the National Heart, Lung, and Blood Institute-sponsored Heart Failure Apprentice Network collected and categorized questions from 5 academic hospitals over 12 months. A total of 174 unanswered questions were collected and analyzed. RESULTS: Compared with 2004, there were more unanswered questions about "whether" to use therapies and fewer about "how" to use therapies. There were fewer questions about what therapeutic targets, therapy adjustment, and combination therapies. There were more questions about whether or how to stop therapies and how to add therapies back. Newly prominent topics, not observed in 2004, including novel therapeutics, refractory ventricular tachycardia, right heart failure, and nutrition/frailty, accounted for 24% of questions. CONCLUSIONS: Compared with 2004, there are fewer unanswered questions about how to use, adjust, and combine therapies. There were more unanswered questions about whether and how to stop therapies. Almost 25% of unanswered questions dealt with topics indicative of more advanced disease which were not observed in 2004.
Authors: G Michael Felker; Kerry L Lee; David A Bull; Margaret M Redfield; Lynne W Stevenson; Steven R Goldsmith; Martin M LeWinter; Anita Deswal; Jean L Rouleau; Elizabeth O Ofili; Kevin J Anstrom; Adrian F Hernandez; Steven E McNulty; Eric J Velazquez; Abdallah G Kfoury; Horng H Chen; Michael M Givertz; Marc J Semigran; Bradley A Bart; Alice M Mascette; Eugene Braunwald; Christopher M O'Connor Journal: N Engl J Med Date: 2011-03-03 Impact factor: 91.245
Authors: Sunita R Jha; Hakeem S K Ha; Louise D Hickman; Malin Hannu; Patricia M Davidson; Peter S Macdonald; Phillip J Newton Journal: Heart Fail Rev Date: 2015-09 Impact factor: 4.214
Authors: John L Sapp; George A Wells; Ratika Parkash; William G Stevenson; Louis Blier; Jean-Francois Sarrazin; Bernard Thibault; Lena Rivard; Lorne Gula; Peter Leong-Sit; Vidal Essebag; Pablo B Nery; Stanley K Tung; Jean-Marc Raymond; Laurence D Sterns; George D Veenhuyzen; Jeff S Healey; Damian Redfearn; Jean-Francois Roux; Anthony S L Tang Journal: N Engl J Med Date: 2016-05-05 Impact factor: 91.245
Authors: Siu-Hin Wan; Susanna R Stevens; Barry A Borlaug; Kevin J Anstrom; Anita Deswal; G Michael Felker; Michael M Givertz; Bradley A Bart; W H Wilson Tang; Margaret M Redfield; Horng H Chen Journal: Circ Heart Fail Date: 2016-08 Impact factor: 8.790
Authors: Bradley A Bart; Steven R Goldsmith; Kerry L Lee; Michael M Givertz; Christopher M O'Connor; David A Bull; Margaret M Redfield; Anita Deswal; Jean L Rouleau; Martin M LeWinter; Elizabeth O Ofili; Lynne W Stevenson; Marc J Semigran; G Michael Felker; Horng H Chen; Adrian F Hernandez; Kevin J Anstrom; Steven E McNulty; Eric J Velazquez; Jenny C Ibarra; Alice M Mascette; Eugene Braunwald Journal: N Engl J Med Date: 2012-11-06 Impact factor: 91.245
Authors: Horng H Chen; Kevin J Anstrom; Michael M Givertz; Lynne W Stevenson; Marc J Semigran; Steven R Goldsmith; Bradley A Bart; David A Bull; Josef Stehlik; Martin M LeWinter; Marvin A Konstam; Gordon S Huggins; Jean L Rouleau; Eileen O'Meara; W H Wilson Tang; Randall C Starling; Javed Butler; Anita Deswal; G Michael Felker; Christopher M O'Connor; Raphael E Bonita; Kenneth B Margulies; Thomas P Cappola; Elizabeth O Ofili; Douglas L Mann; Víctor G Dávila-Román; Steven E McNulty; Barry A Borlaug; Eric J Velazquez; Kerry L Lee; Monica R Shah; Adrian F Hernandez; Eugene Braunwald; Margaret M Redfield Journal: JAMA Date: 2013-12-18 Impact factor: 56.272
Authors: David Snipelisky; Marat Fudim; Antonio Perez; Matthew Nayor; Natasha M Lever; David S Raymer; Andrew N Rosenbaum; Omar AbouEzzeddine; Adrian F Hernandez; Lynne Warner Stevenson; Lauren G Gilstrap Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2020-08-19
Authors: Lauren G Gilstrap; Michael E Chernew; Christina A Nguyen; Sartaj Alam; Barbara Bai; J Michael McWilliams; Bruce E Landon; Mary Beth Landrum Journal: JAMA Netw Open Date: 2019-08-02
Authors: Lauren Gilstrap; Andrea M Austin; Barbara Gladders; Parag Goyal; A James O'Malley; Amber Barnato; Anna N A Tosteson; Jonathan S Skinner Journal: J Am Geriatr Soc Date: 2021-06-15 Impact factor: 7.538
Authors: Lauren G Gilstrap; Lynne W Stevenson; Roy Small; Ron Parambi; Rose Hamershock; Jeffrey Greenberg; Christina Carr; Roya Ghazinouri; Lisa Rathman; Elizabeth Han; Mandeep R Mehra; Akshay S Desai Journal: J Am Heart Assoc Date: 2018-08-07 Impact factor: 5.501