Bridging Treatment Implementation Gaps in Patients With Heart Failure JACC Focus Seminar 2/3

Heart failure (HF) is a leading cause of death and disability in older adults. Despite decades of high-quality evidence to support their use, guideline-directed medical therapies (GDMTs) that reduce death and disease burden in HF have been suboptimally implemented. Approaches to closing care gaps have focused largely on strategies proven to be ineffective, whilst effective interventions shown to improve GDMT uptake have not been instituted. This review synthesizes implementation interventions that increase the uptake of GDMT, discusses barriers and facilitators of implementation, summarizes conceptual frameworks in implementation science that could improve knowledge uptake, and offers suggestions for trial design that could better facilitate end-of-trial implementation. We propose an evidence-to-care conceptual model that could foster the simultaneous generation of evidence and long-term implementation. By adopting principles of implementation science, policymakers, researchers, and clinicians can help reduce the burden of HF on patients and health care systems worldwide. (J Am Coll Cardiol 2023;82:544-558) & COPY; 2023 by the American College of Cardiology Foundation.

Automated summary

Heart failure is a leading cause of death and disability in older adults, but the implementation of guideline-directed medical therapies to reduce the burden of the disease has been suboptimal. This review discusses interventions that increase the uptake of these therapies, barriers and facilitators of implementation, conceptual frameworks in implementation science, and trial design suggestions. An evidence-to-care conceptual model is proposed to generate evidence and promote long-term implementation. By applying principles of implementation science, policymakers, researchers, and clinicians can help alleviate the burden of heart failure worldwide.