The Wider Considerations in Closing Chronic Disease Gaps – Focus on Heart Failure and Implementation

Abstract

Background: Heart failure (CHF) is predominately a chronic disease. There are overlaps in HF and chronic disease research and care. Chronic disease and HF research is conducted with multiple goals. The overarching goal is “optimized patient outcomes at maximum cost-effectiveness”. Observations and patients, however, can come with many variables; thus, we see gaps in clinical translation. This document discusses an argument for three important gaps common to HF and chronic disease, i.e., screening, self-management, and patient-reported outcomes (PRO), and provides a glance of how it could fit into the evidence tree with a focus. Pertinent arguments for a framework for health services and models of care are provided as a prelude to future consensus. Methodology: 1) A preliminary literature review to identify a taxonomy for cardiovascular research and 2) a review of the published literature describing the translation of research studies into clinical practice for cardiovascular disorders. We identified a spectrum from observational to large randomized controlled trials to post-marketing studies. Results and Discussion: Research design in context to the above gaps are discussed.We then propose 6 steps to facilitate this: 1) Research design; 2) Research application (translation) i. routine ii. challenges; 3. Transforming research to translational level; 4. Funding and infrastructure; 5. CCRE and collaboration; 6. Governance and cost-efficacy. Conclusion: 1. Implementation research is a neglected area that aims to link research findings to improved patient outcomes, in an efficient and effective way. 2. Skills required to perform implementation research include a complex interplay of factors. 3. Ways to maximize translational impacts for chronic disease research to clinical practice are described in a CHF context.