From the Guidelines
The newest guidelines for heart failure that could serve as the basis for a quality improvement project include several key areas, with a primary focus on implementing the four foundational medication classes—SGLT2 inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and ACE inhibitors/ARBs/ARNIs, as recommended by the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1.
Key Areas for Quality Improvement
- Implementation of the four foundational medication classes, which can significantly reduce hospitalizations and mortality, as supported by the 2023 JACC focus seminar on implementing guideline-directed medical therapy for heart failure 1.
- Optimizing these medications to target doses, as emphasized in the 2024 update to the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure 1.
- Other potential projects include:
- Implementing structured transitions of care programs with early follow-up within 7-14 days of discharge.
- Remote patient monitoring with daily weight and symptom tracking.
- Cardiac rehabilitation referrals for heart failure patients.
- Screening for and managing iron deficiency with IV iron supplementation when appropriate.
- Addressing social determinants of health that affect medication adherence and self-care, as highlighted in the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1.
Rationale
These interventions target the pathophysiology of heart failure by reducing cardiac workload, neurohormonal activation, and fluid retention while improving cardiac remodeling and functional capacity, ultimately leading to better patient outcomes and reduced healthcare utilization, as discussed in the 2023 JACC focus seminar on implementing guideline-directed medical therapy for heart failure 1.
Evidence-Based Recommendations
The 2024 update to the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure provides new performance measures and quality measures, including the use of sodium-glucose cotransporter-2 inhibitors for patients with heart failure with reduced ejection fraction, and the optimization of guideline-directed medical therapy prior to intervention for chronic secondary severe mitral regurgitation 1.
Conclusion is not allowed, so the response is ended here.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Newest Guidelines for Heart Failure
The newest guidelines for heart failure emphasize the importance of Guideline-Directed Medical Therapy (GDMT) in improving outcomes for patients with heart failure with reduced ejection fraction (HFrEF) 2, 3, 4.
Key Components of GDMT
The key components of GDMT include:
- Beta-blockers
- Renin-angiotensin system inhibitors (RASi)
- Angiotensin receptor blockers (ARBs)
- Angiotensin receptor neprilysin inhibitors (ARNIs)
- Mineralocorticoid receptor antagonists (MRAs)
- Sodium-glucose cotransporter 2 inhibitors
Quality Improvement Projects
Quality improvement projects can be done on the following topics:
- Remote optimization of GDMT in patients with HFrEF 2
- Inpatient optimization of GDMT in acute HFrEF 3
- Improving the use of GDMT in community patients with newly diagnosed HFrEF 4
- Implementing a multiregional quality improvement initiative to enhance the use of quadruple medical therapy (QMT) in routine practice 5
- Closing the care gap in heart failure care through quality improvement initiatives 6
Potential Interventions
Potential interventions for quality improvement projects include:
- Navigator-led remote optimization of GDMT
- Multidisciplinary learning to share strategies for formulary changes, electronic health record tools, and patient resources
- Site-level feedback reports
- Implementation of a learning collaborative model to promote improvements in QMT use
- Initiating and/or uptitrating beta-blockers and RASi in patients with HFrEF 3