Managing Heart Failure in the Community Setting

Transcript: Deepak L. Bhatt, MD, MPH: Let’s move on now to some therapies that are on the horizon. Before getting into specifics of newer and fancier drugs, Nancy, maybe you could just start off with some advice for community physicians managing patients with heart failure? What does the future hold for them?

Nancy M. Albert, PhD, CCNS: I have 3 bits of advice for community physicians. The first is that heart failure is complex and managing patients with heart failure is also very complex. It’s very important for community physicians, but really for all providers to keep up with the literature, whether that means attending webinars, going to national meetings, or reading the literature, especially guidelines or scientific statements as they come out so that we can make sure we’re giving the best therapies to our patients and are following guideline-directed medical therapy.

Second, we all need to get better at figuring out how to develop systems or processes within our hospitals or within our office settings that help us do the right thing at the right time. Maybe this includes going into Epic and having a program created that forces us to say why we’re not giving the right drug, or reminds us that it’s time to up-titrate a drug so that we can make sure that our patients have the best chance of not just recovery from a decompensation episode but also a good maintenance period so they live the best quality of life possible. We know that heart failure has a lot of symptoms, and patients are often running around with a very poor quality of life. So if we can enhance that, that would be great.

My third message for community providers is that we all need to be better at being redundant in communicating with our patients. Oftentimes, when patients hear messages from us, they’re not ready for the message they receive. We may say things about diet or exercise (or whatever the theme is we’re trying to push upon them) and help them understand the benefit. If we don’t repeat it constantly, they may miss the point and never come back to it again. So, we need to be better at being redundant with our messages and making sure that we help our patients understand the relevance of what we’re doing. For example, if we start a new drug, we know that most drugs in the heart failure family of medicines need to be up-titrated. So it’s a stepped approach and we need to start off right at the beginning explaining to patients that, “We’re going to need to see you in 2 weeks.” Or, “We may need to talk to you on the phone or have a teleconference in 2 or 3 weeks so that we can up-titrate the drug.” If patients get those right messages, they understand the importance of coming back and they understand the importance of interacting with their provider.

Transcript Edited for Clarity