Clinical inertia and optimization of heart failure therapy

With Chris Kapelios, Onassis Cardiac Surgery Center, Athens - Greece & Gianluigi Savarese, Karolinska University Hospital, Stockholm - Sweden. This HFA CardioTalk podcast episode addresses Clinical inertia and optimization of heart failure therapy. The data we have on use of HF medications come from registries and may not be generalizable to unselected, real-world populations. The proportion of HFrEF patients treated with optimal medical therapy differs considerably among registries (between 70% to >90% for a beta-blocker, 60% to >90% for RASi, 15-45% for ARNI, 30-60% for MRA). It is well documented that optimal HFrEF treatment leads to better quality of life, and reduction in mortality, HF hospitalizations and healthcare costs. Clinical inertia is the lack of treatment intensification in patients not on optimized therapy. Its manifestations may differ from country to country, but it is always present, irrespective of whether the approach to HF medication initiation is sequential or in parallel. Increase of awareness, collaboration of all healthcare professionals, and use of checklists and digital tools are among the measures we can apply to tackle clinical inertia.