Implementation Science to Achieve Equity in Heart Failure Care: A Scientific Statement From the American Heart Association

• Published in: Circulation (New York, N.Y.) Vol. 149; no. 19; p. e1143
• Main Authors: Breathett, Khadijah, Lewsey, Sabra, Brownell, Nicholas K, Enright, Kendra, Evangelista, Lorraine S, Ibrahim, Nasrien E, Iturrizaga, Jose, Matlock, Daniel D, Ogunniyi, Modele O, Sterling, Madeline R, Van Spall, Harriette G C
• Format: Journal Article
• Language: English
• Published: United States 07-05-2024
• Subjects: American Heart Association; Health Equity; Healthcare Disparities; Heart Failure - diagnosis; Heart Failure - therapy; Humans; Implementation Science; United States; United States; heart failure; health disparities; women’s health; health equity; heart transplant; pragmatic clinical trials as topic; AHA Scientific Statements; implementation science; race factors
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/CIR.0000000000001231

Guideline-directed medical therapies and guideline-directed nonpharmacological therapies improve quality of life and survival in patients with heart failure (HF), but eligible patients, particularly women and individuals from underrepresented racial and ethnic groups, are often not treated with these therapies. Implementation science uses evidence-based theories and frameworks to identify strategies that facilitate uptake of evidence to improve health. In this scientific statement, we provide an overview of implementation trials in HF, assess their use of conceptual frameworks and health equity principles, and provide pragmatic guidance for equity in HF. Overall, behavioral nudges, multidisciplinary care, and digital health strategies increased uptake of therapies in HF effectively but did not include equity goals. Few HF studies focused on achieving equity in HF by engaging stakeholders, quantifying barriers and facilitators to HF therapies, developing strategies for equity informed by theory or frameworks, evaluating implementation measures for equity, and titrating strategies for equity. Among these HF equity studies, feasibility was established in using various educational strategies to promote organizational change and equitable care. A couple include ongoing randomized controlled pragmatic trials for HF equity. There is great need for additional HF implementation trials designed to promote delivery of equitable guideline-directed therapy.