Implementation of Guidelines in Heart Failure: Problems and Potential Solutions

Abstract

Heart failure (HF) is a long-term condition associated with high mortality, recurrent hospitalisations and a poor quality of life. Several classes of medications (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, β-blockers, If channel blockers, angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor antagonists and sodium–glucose cotransporter inhibitors) have demonstrated substantial benefits regarding clinical outcomes and have therefore been included in international guidelines for the management of HF with a high level of recommendation. However, observational studies show that the implementation of these guidelines remains suboptimal. Rates of prescription of recommended medications are highly variable between centres and underdosage is common. Factors related to the patient, the physician, the cost, the organisation of healthcare systems and, finally, the guidelines themselves play a role in this. These affect clinical outcomes and low adherence to guidelines is associated with an increased risk of mortality or rehospitalisation for HF. Education programmes targeting both patients and physicians should be developed to improve practice and awareness. Disease management programmes that involve cardiologists, GPs, HF nurses and other health professionals are also needed to fill the gap in treatment after a hospitalisation for HF and ensure regular follow-up with rapid uptitration of HF medications if tolerated. Better collaboration is needed between patients, health professionals, policymakers and payers to reduce the burden of HF.