Stakeholder Perspectives on a Heart Failure With Reduced Ejection Fraction Polypill: A Multi-Center Mixed Methods Study.

Autor:	Chen JC; Department of Medicine, Division of Cardiology, Washington University in St. Louis School of Medicine, St. Louis, MO (J.C.C., M.A., M.D.H., A.A.)., DeJong C; Department of Medicine, Division of Cardiology, Washington University in St. Louis School of Medicine, St. Louis, MO (J.C.C., M.A., M.D.H., A.A.).; VA Palo Alto Health Care System, CA (C.D.J.)., Agarwal M; Department of Medicine, Division of Cardiology, Washington University in St. Louis School of Medicine, St. Louis, MO (J.C.C., M.A., M.D.H., A.A.)., Hairston AM; University of Missouri School of Medicine, Columbia, MO (A.M.H.)., Durstenfeld MS; Department of Medicine, Division of Cardiology, University of California San Francisco, San Francisco, CA (M.S.D.)., McKay V; Brown School, Washington University in St. Louis, St. Louis, MO (V.M.K.)., Huffman MD; Department of Medicine, Division of Cardiology, Washington University in St. Louis School of Medicine, St. Louis, MO (J.C.C., M.A., M.D.H., A.A.).; The George Institute for Global Health, University of New South Wales, Sydney, Australia (M.D.H.)., Hsue PY; Department of Medicine, Division of Cardiology, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA (P.Y.H.)., Agarwal A; Department of Medicine, Division of Cardiology, Washington University in St. Louis School of Medicine, St. Louis, MO (J.C.C., M.A., M.D.H., A.A.).
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2024 Nov; Vol. 17 (11), pp. e011121. Date of Electronic Publication: 2024 Nov 06.
DOI:	10.1161/CIRCOUTCOMES.124.011121
Abstrakt:	Background: A polypill containing all 4 classes of guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF) has been proposed to change the heart failure treatment paradigm. The acceptability, appropriateness, and feasibility of a HFrEF polypill-based strategy are unknown. The purpose of this study was to elicit patients' and providers' priorities in the design of HFrEF polypills. Methods: From April 2023 to December 2023, we conducted a convergent parallel mixed-methods study at Washington University in St. Louis, the University of California, San Francisco, and the American College of Cardiology. We administered physician surveys containing adapted implementation outcome measures to elicit physicians' perspectives on the acceptability, feasibility, and appropriateness of a HFrEF polypill (Likert scale ranging from 1 [low] to 5 [high]). We used a purposive sampling frame to select patients and physicians for in-depth interviews. Using semi-structured interview guides, we elicited participants' perspectives on current HFrEF care, HFrEF polypill design, and supportive strategies. The Consolidated Framework for Implementation Research v2.0 guided thematic analysis. Results: Of the 214 survey respondents across the United States, physicians agreed that HFrEF polypills are highly acceptable (mean [SD], 4.2 [0.7]), highly appropriate (4.1 [0.8]), and highly feasible (4.1 [0.7]). Key themes from 9 patient and 22 provider interviews included the following: (1) current determinants of HFrEF care, including medication adherence, variations in clinical practice, and health care access, (2) provider-level differences in preferred HFrEF polypill design, (3) cost and equity considerations in the implementation of HFrEF polypills, and (4) research priorities for evaluating polypill effectiveness and implementation. Conclusions: A HFrEF polypill-based strategy was viewed as highly acceptable, appropriate, and feasible by patients and physicians. Participants described key priorities in HFrEF polypill design, titratability, and potential impacts on health equity that will directly inform future randomized controlled trials. Competing Interests: Dr Huffman has received travel support from the World Heart Federation. Dr Huffman has an appointment at The George Institute for Global Health, which holds a patent and license, has received investment funding with the intent to commercialize fixed-dose combination therapy through its social enterprise business, George Medicines. Drs Huffman and Agarwal plan to submit patents for heart failure with reduced ejection fraction polypills. Dr DeJong’s spouse is employed by and holds stock in iRhythm Technologies. The other authors report no conflicts.
Databáze:	MEDLINE
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