Putting New Heart Failure Therapies into Practice

SEPTEMBER 22, 2016
W. Todd Penberthy,PhD
Ultimately, the discoveries and achievements of clinical research do not matter if physicians do not implement the guidelines created from those results. Paul Heidenreich, MD, MS, professor of medicine (cardiovascular) and professor by courtesy of health research and policy at the VA Palo Alto Health Care System, examined the limiting factors controlling widespread guideline implementation. In a presentation at HFSA 2016, he described the historical implementation time frames ‑‑ initial guideline recommendation to widespread practice. In the end, he noted that electronic records can be expected to shorten this timeframe.
Heidenreich pointed out that it routinely takes about 18 years before a novel drug is accepted and commonly used in practice. With the threshold for widespread implementation defined as use by 90% of polled physicians, the “Get-With-the-Guidelines” program implemented in hospitals by the AHA took 18 years before ACE inhibitors were commonly implemented, as had been recommended for treating left ventricular systolic dysfunction (LVSD). In the case of evidence-based recommendations on the use of beta blockers, it was not until 2011 that the guideline-recommended drug was commonly implemented. This included metoprolol succinate and carvedilol, but not the short-acting metoprolol. Again, it was about 18 years from initial recommendation time to widespread implementation. Aldosterone candidates for LVSD face similar timeframes.
Heidenreich identified several factors that he said control implementation of new medications into common practice. First, each new therapy will have its own distinct barriers. In the US especially, guidelines are needed before most physicians (and payers) will adopt new remedies. The value of care delivered is getting more and more attention, as it can dramatically affect implementation. “I don’t think one can assume that just because the drug has a benefit you are going to get things implemented,” Heidenreich said.

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