Study Shows National Heart Failure Initiative Improved Care, Treatment for Patients in Kansas City, Across the Country

KANSAS CITY, Mo. — A nationwide heart failure initiative launched by the American Heart Association substantially improved care for patients—and access to care—by increasing guideline-directed lifesaving heart failure therapy use, according to a new study led by researchers at Saint Luke’s Mid America Heart Institute published in Circulation: Heart Failure.

Approximately 6.7 million adults have heart failure in the U.S. That number is expected to rise to 8.7 million by 2030. Nearly half of those hospitalized with worsening heart failure have heart failure with reduced ejection fraction (HFrEF), which is associated with a high mortality rate (75.3%) and high mortality/readmission rates at five years (96.4%). 

Previous studies have shown significant improvements when these patients receive a combination of four medications, known as quadruple medical therapy: angiotensin receptor-neprilysin inhibitor (ARNi), evidence-based specific beta-blocker (BB), mineralocorticoid antagonist (MRA), and sodium-glucose cotransporter 2 inhibitor (SGLTI2i). Yet, this proven quadruple medical therapy is used in less than 20% of patients with HFrEF.

In 2021, the American Heart Association launched IMPLEMENT-HF™—a three-year initiative across seven regions in the U.S., including in Kansas City, to increase healthy time at home for patients with heart failure—through its voluntary hospital-based program, Get With The Guidelines® - Heart Failure. The large-scale initiative focused on increasing the use of quadruple medical therapy, assessment of health-related social needs, patient empowerment and health care professional education.

The study included more than 43,500 patients who met certain criteria from 67 sites that participated in the IMPLEMENT-HF initiative. 

Over the study period, researchers found evidence IMPLEMENT-HF was associated with a substantial and equitable improvement in quadruple medical therapy use upon patients’ discharge from the hospital (from 4.7% to 44.6%) and at 30 days after discharge (from 0% to 44.8%). 

The study also found substantial increases in the adoption of health-related social needs assessment, helping connect patients with resources to better support their recovery.

“This is a major step forward in heart failure care,” said Andrew Sauer, MD, cardiologist at Saint Luke’s Mid America Heart Institute and lead author of the study. “We know that early introduction of these crucial therapies for heart failure patients with reduced ejection fraction can lead to better outcomes and quality of life after they leave the hospital.”

Although researchers noted variation in implementation among regions in certain performance measures, there was a notable quarterly improvement overall. 

Authors of the study say this analysis highlights a scalable model to address the underutilization of guideline-directed medical therapy in HFrEF, improving adherence to evidence-based care and equity across sex and racial/ethnic groups. Including health-related social needs assessment also underscores the importance of addressing social determinants of health (SDOH) in optimizing patient outcomes.

“The IMPLEMENT-HF initiative demonstrates the power of collaborative, data-driven quality improvement in the care of patients suffering from heart failure,” said Gregg Fonarow, MD, cardiologist at UCLA Health and senior author of the study. “The American Heart Association seeks to increase patients’ healthy days at home and this transformative effort proved to significantly increase life-saving therapy use and improved equity in care across seven regions in the U.S.”

The study authors noted more research is needed to explore the relationship between enhanced performance measures, like quadruple medical therapy in multidisciplinary team-oriented initiatives such as IMPLEMENT-HF, and clinical outcomes.

Read the full article, Multiregional Implementation Initiative’s Impact on Guideline-Based Performance Measures for Patients Hospitalized with Heart Failure: IMPLEMENT-HF, in Circulation: Heart Failure.