Top Things to Know: Implementation Science to Achieve Equity in HF Care
Published: April 03, 2024
Prepared by Paul St. Laurent, DNP, RN, Vice President, Science and Medicine American Heart Association
- Guideline-directed medical therapies (GDMT) and non-pharmacologic therapies improve quality of life and survival in patients with HF, but there are disparities in treatment particularly for women and those from underrepresented racial and ethnic groups.
- This statement provides an overview of implementation trials in HF, assesses the use of conceptual frameworks and health equity principles, and provides pragmatic guidance for equity in HF.
- Implementation science uses evidence-based theories and frameworks to identify strategies that facilitate the uptake of evidence to improve health.
- Implementation science studies can use qualitative studies, mixed-methods, quasi-experimental designs, randomized controlled trials, and community-based participatory research.
- Although some interventions tested in implementation science studies for HF such as behavioral nudges, clinical decision support and digital health tools have been effective in increasing the uptake of therapies in HF, few studies have focused on achieving equity in HF care.
- Equity-focused implementation science studies prioritize the identification of barriers and facilitators to equitable treatment, engage diverse stakeholders, and use specific equity measures and outcomes for evaluation.
- Strategies for equity in HF care include bias reduction training, standardized assessments of social history, group dynamics training, and addressing social determinants of health including structural racism, socioeconomic deprivation, social bias, and healthcare system barriers.
- This statement emphasizes the importance of engaging stakeholders, training and educating clinicians, and using evaluative and iterative strategies to facilitate implementation and improve equity in HF care.
- Implementation science provides a pivotal opportunity to close HF gaps in treatment when developed with equity as the focus.
- More implementation science studies are needed to assess the real-world effectiveness and implementation of multicomponent strategies to achieve equity in HF care and improve the uptake of evidence-based therapies for all eligible patients.
Citation
Breathett K, Lewsey S, Brownell NK, Enright K, Evangelista LS, Ibrahim NE, Iturrizaga J, Matlock DD, Ogunniyi MO, Sterling MR, Van Spall HGC; on behalf of the American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; and Council on Quality of Care and Outcomes Research. Implementationscience to achieve equity in heart failure care: a scientific statement from the American Heart Association. Circulation. Published online April 3, 2024. doi: 10.1161/CIR.0000000000001231