Patient Perceptions and Familiarity With Medical Therapy for Heart Failure

This study surveyed patients with chronic heart failure to better understand their experiences and perceptions of living with heart failure, including their familiarity and concerns with important guideline-directed medical therapies. Key PointsQuestionWhat are patient perceptions and priorities while living with heart failure (HF) and when choosing therapies for HF? FindingsIn this survey study of 429 patients with HF, respondents reported functioning independently, reducing morbidity/mortality, and minimizing HF symptoms as their most important priorities. Most survey responders reported familiarity with beta -blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics; less than 25% reported familiarity with angiotensin receptor-neprilysin inhibitors or mineralocorticoid receptor antagonists. MeaningMany patients are not familiar with guideline-directed medical therapies for HF and/or question the safety and effectiveness of therapy, and these findings may significantly contribute to underutilization of guideline-directed medical therapies observed in prior studies. ImportanceThere 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. ObjectiveTo 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 ParticipantsStudy 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 MeasuresThe 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. ResultsOf 30707 KnowledgePanel members who received the initial survey, 15091 (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 beta -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 beta -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 beta -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 RelevanceIn 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.