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Original Investigation
November 17, 2019

Patient Perceptions and Familiarity With Medical Therapy for Heart Failure

Author Affiliations
  • 1Duke Clinical Research Institute, Durham, North Carolina
  • 2Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
  • 3Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
  • 4Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora
  • 5Division of Cardiology, Denver Health Medical Center, Denver, Colorado
  • 6Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
  • 7Division of Cardiology, University of New Mexico School of Medicine, Albuquerque
  • 8Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 9Deputy Editor, JAMA Cardiology
  • 10Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
  • 11Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, Baltimore
  • 12Ahmanson–University of California, Los Angeles, Cardiomyopathy Center, University of California, Los Angeles
  • 13Section Editor, JAMA Cardiology
JAMA Cardiol. Published online November 17, 2019. doi:https://doi.org/10.1001/jamacardio.2019.4987
Key Points

Question  What are patient perceptions and priorities while living with heart failure (HF) and when choosing therapies for HF?

Findings  In this survey study of 429 patients with HF, respondents reported functioning independently, reducing morbidity/mortality, and minimizing HF symptoms as their most important priorities. Most survey responders reported familiarity with β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics; less than 25% reported familiarity with angiotensin receptor–neprilysin inhibitors or mineralocorticoid receptor antagonists.

Meaning  Many patients are not familiar with guideline-directed medical therapies for HF and/or question the safety and effectiveness of therapy, and these findings may significantly contribute to underutilization of guideline-directed medical therapies observed in prior studies.

Abstract

Importance  There are major gaps in use of guideline-directed medical therapy (GDMT) for patients with heart failure (HF). Patient-reported data outlining patient goals and preferences associated with GDMT are not available.

Objective  To survey patients with chronic HF to better understand their experiences and perceptions of living with HF, including their familiarity and concerns with important GDMT therapies.

Design, Setting, and Participants  Study participants were recruited from the GfK KnowledgePanel, a probability-sampled online panel representative of the US adult population. English-speaking adults who met the following criteria were eligible if they were (1) previously told by a physician that they had HF; (2) currently taking medications for HF; and (3) had no history of left ventricular assist device or cardiac transplant. Data were collected between October and November 2018. Analysis began in December 2018.

Main Outcomes and Measures  The survey included 4 primary domains: (1) relative importance of disease-related goals, (2) challenges associated with living with HF, (3) decision-making process associated with HF medication use, and (4) awareness and concerns about available HF medications.

Results  Of 30 707 KnowledgePanel members who received the initial survey, 15 091 (49.1%) completed the screening questions, 440 were eligible and began the survey, and 429 completed the survey. The median (interquartile range) age was 68 (60-75) years and most were white (320 [74.6%]), male (304 [70.9%]), and had at least a high school education (409 [95.3%]). Most survey responders reported familiarity with β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. Overall, 107 (24.9%) reported familiarity with angiotensin receptor–neprilysin inhibitors or mineralocorticoid receptor antagonists. Overall, 136 patients (42.5%) reported have safety concerns regarding angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and 133 (38.5%) regarding β-blockers, 35 (37.9%) regarding mineralocorticoid receptor antagonists, 38 (36.5%) regarding angiotensin receptor–neprilysin inhibitors, and 123 (37.2%) regarding diuretics. Between 27.7% (n = 26) and 38.5% (n = 136) reported concerns regarding the effectiveness of β-blockers, angiotensin receptor–neprilysin inhibitors, mineralocorticoid receptor antagonists, or diuretics, while 41% (n = 132) were concerned with the effectiveness of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers.

Conclusions and Relevance  In this survey study, many patients were not familiar with GDMT for HF, with familiarity lowest for angiotensin receptor–neprilysin inhibitors and mineralocorticoid receptor antagonists. Among patients not familiar with these therapies, significant proportions questioned their effectiveness and/or safety. Enhanced patient education and shared decision-making support may be effective strategies to improve the uptake of GDMT for HF in US clinical practice.

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