Marc D Samsky1,2, Li Lin1, Stephen J Greene1,2, Steven J Lippmann3, Pamela N Peterson4,5, Paul A Heidenreich6, Warren K Laskey7, Clyde W Yancy8,9, Melissa A Greiner3, N Chantelle Hardy3, Abhishek Kavati10, Siyeon Park11, Robert J Mentz1,2, Gregg C Fonarow12,13, Emily C O'Brien1,3. 1. Duke Clinical Research Institute, Durham, North Carolina. 2. Division of Cardiology, Duke University School of Medicine, Durham, North Carolina. 3. Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina. 4. Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora. 5. Division of Cardiology, Denver Health Medical Center, Denver, Colorado. 6. Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California. 7. Division of Cardiology, University of New Mexico School of Medicine, Albuquerque. 8. Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 9. Deputy Editor. 10. Novartis Pharmaceuticals Corporation, East Hanover, New Jersey. 11. Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, Baltimore. 12. Ahmanson-University of California, Los Angeles, Cardiomyopathy Center, University of California, Los Angeles. 13. Section Editor.
Abstract
Importance: There are major gaps in use of guideline-directed medical therapy (GDMT) for patients with heart failure (HF). Patient-reported data outlining patient goals and preferences associated with GDMT are not available. Objective: To survey patients with chronic HF to better understand their experiences and perceptions of living with HF, including their familiarity and concerns with important GDMT therapies. Design, Setting, and Participants: Study participants were recruited from the GfK KnowledgePanel, a probability-sampled online panel representative of the US adult population. English-speaking adults who met the following criteria were eligible if they were (1) previously told by a physician that they had HF; (2) currently taking medications for HF; and (3) had no history of left ventricular assist device or cardiac transplant. Data were collected between October and November 2018. Analysis began in December 2018. Main Outcomes and Measures: The survey included 4 primary domains: (1) relative importance of disease-related goals, (2) challenges associated with living with HF, (3) decision-making process associated with HF medication use, and (4) awareness and concerns about available HF medications. Results: Of 30 707 KnowledgePanel members who received the initial survey, 15 091 (49.1%) completed the screening questions, 440 were eligible and began the survey, and 429 completed the survey. The median (interquartile range) age was 68 (60-75) years and most were white (320 [74.6%]), male (304 [70.9%]), and had at least a high school education (409 [95.3%]). Most survey responders reported familiarity with β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. Overall, 107 (24.9%) reported familiarity with angiotensin receptor-neprilysin inhibitors or mineralocorticoid receptor antagonists. Overall, 136 patients (42.5%) reported have safety concerns regarding angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and 133 (38.5%) regarding β-blockers, 35 (37.9%) regarding mineralocorticoid receptor antagonists, 38 (36.5%) regarding angiotensin receptor-neprilysin inhibitors, and 123 (37.2%) regarding diuretics. Between 27.7% (n = 26) and 38.5% (n = 136) reported concerns regarding the effectiveness of β-blockers, angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, or diuretics, while 41% (n = 132) were concerned with the effectiveness of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. Conclusions and Relevance: In this survey study, many patients were not familiar with GDMT for HF, with familiarity lowest for angiotensin receptor-neprilysin inhibitors and mineralocorticoid receptor antagonists. Among patients not familiar with these therapies, significant proportions questioned their effectiveness and/or safety. Enhanced patient education and shared decision-making support may be effective strategies to improve the uptake of GDMT for HF in US clinical practice.
Importance: There are major gaps in use of guideline-directed medical therapy (GDMT) for patients with heart failure (HF). Patient-reported data outlining patient goals and preferences associated with GDMT are not available. Objective: To survey patients with chronic HF to better understand their experiences and perceptions of living with HF, including their familiarity and concerns with important GDMT therapies. Design, Setting, and Participants: Study participants were recruited from the GfK KnowledgePanel, a probability-sampled online panel representative of the US adult population. English-speaking adults who met the following criteria were eligible if they were (1) previously told by a physician that they had HF; (2) currently taking medications for HF; and (3) had no history of left ventricular assist device or cardiac transplant. Data were collected between October and November 2018. Analysis began in December 2018. Main Outcomes and Measures: The survey included 4 primary domains: (1) relative importance of disease-related goals, (2) challenges associated with living with HF, (3) decision-making process associated with HF medication use, and (4) awareness and concerns about available HF medications. Results: Of 30 707 KnowledgePanel members who received the initial survey, 15 091 (49.1%) completed the screening questions, 440 were eligible and began the survey, and 429 completed the survey. The median (interquartile range) age was 68 (60-75) years and most were white (320 [74.6%]), male (304 [70.9%]), and had at least a high school education (409 [95.3%]). Most survey responders reported familiarity with β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. Overall, 107 (24.9%) reported familiarity with angiotensin receptor-neprilysin inhibitors or mineralocorticoid receptor antagonists. Overall, 136 patients (42.5%) reported have safety concerns regarding angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and 133 (38.5%) regarding β-blockers, 35 (37.9%) regarding mineralocorticoid receptor antagonists, 38 (36.5%) regarding angiotensin receptor-neprilysin inhibitors, and 123 (37.2%) regarding diuretics. Between 27.7% (n = 26) and 38.5% (n = 136) reported concerns regarding the effectiveness of β-blockers, angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, or diuretics, while 41% (n = 132) were concerned with the effectiveness of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. Conclusions and Relevance: In this survey study, many patients were not familiar with GDMT for HF, with familiarity lowest for angiotensin receptor-neprilysin inhibitors and mineralocorticoid receptor antagonists. Among patients not familiar with these therapies, significant proportions questioned their effectiveness and/or safety. Enhanced patient education and shared decision-making support may be effective strategies to improve the uptake of GDMT for HF in US clinical practice.
Authors: Marc D Samsky; Carmelo A Milano; Salpy Pamboukian; Mark S Slaughter; Emma Birks; Steven Boyce; Samer S Najjar; Akinobu Itoh; Bruce Reid; Nahush Mokadam; Keith D Aaronson; Francis D Pagani; Joseph G Rogers Journal: ASAIO J Date: 2021-10-01 Impact factor: 3.826
Authors: Peter G Szilagyi; Christina S Albertin; Dennis Gurfinkel; Alison W Saville; Sitaram Vangala; John D Rice; Laura Helmkamp; Gregory D Zimet; Rebecca Valderrama; Abigail Breck; Cynthia M Rand; Sharon G Humiston; Allison Kempe Journal: Vaccine Date: 2020-08-02 Impact factor: 4.169
Authors: Adam D DeVore; Claude Larry Hill; Laine E Thomas; Nancy M Albert; Javed Butler; J Herbert Patterson; Adrian F Hernandez; Fredonia B Williams; Xian Shen; John A Spertus; Gregg C Fonarow Journal: ESC Heart Fail Date: 2021-11-17