Additional HFrEF education and patient-engagement tools

In the EPIC-HF trial, a patient-activation tool which was delivered electronically prior to a cardiology clinic visit improved clinician intensification of guideline-directed medical therapies in nearly half of heart failure with reduced ejection fraction (HFrEF) patients.

The hypothesis of the EPIC-HF trial (NCT03334188) was that the use of guideline-directed medical therapies could be improved by encouraging patients to engage providers in prescribing decisions. Prof. Larry Allen (University of Colorado School of Medicine, USA) presented the results of the trial, in which 290 HFrEF patients were randomised 1:1 to receive usual care or additional patient-engagement and education tools [1,2]. These tools consisted of a 3-minute video and a 1-page medication checklist, delivered electronically 1 week, 3 days, and 24 hours prior to a visit at a cardiology clinic. The primary endpoint was the percentage of patients with medication initiations and dose intensifications from immediately preceding the cardiology clinic visit to 30 days thereafter. Pre-clinic data showed that no patients were on target doses of beta-blocker, sacubitril/valsartan, and mineralocorticoid-receptor antagonists. The median age was 65 years, 29% were female, and median left ventricular ejection fraction (LVEF) was 32%.

In the 30 days after the visit to the clinic, the percentage of patients who met the primary endpoint was 49% in the intervention group and 29.7% in the control group (P=0.001). Most changes were made during the clinician encounter itself and involved dose uptitrations of HFrEF medications already prescribed. There were no deaths, nor significant differences in hospitalisation or emergency department visits at 30 days between groups.

“This approach validates and promotes a culture of collaboration between patients and their doctors,” Prof. Allen concluded, “leading to more productive clinic visits with optimised medication prescribing, which can ultimately improve patient outcomes.”

1. 
   
   1. Allen LA, et al. An Electronically Delivered, Patient-activation Tool for Intensification of Medications for Chronic Heart Failure With Reduced Ejection Fraction: The EPIC-HF Trial. LBS.09, AHA Scientific Sessions 2020, 13–17 Nov.
   2. Allen LA, et al. Circulation. 2020 Nov 17. Doi: 10.1161/CIRCULATIONAHA.120.051863.

Posted on 18 February 202118 February 2021