An Electronically delivered, Patient-activation tool for Intensification of medications for Chronic Heart Failure with reduced ejection fraction: Rationale and design of the EPIC-HF trial.
An Electronically delivered, Patient-activation tool for Intensification of medications for Chronic Heart Failure with reduced ejection fraction: Rationale and design of the EPIC-HF trial.
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一种电子传输的患者激活工具，用于强化治疗射血分数降低的慢性心力衰竭的药物：EPIC-HF 试验的基本原理和设计。
DOI：
10.1016/j.ahj.2020.08.013
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发表时间：
2020
影响因子：
4.8
通讯作者：
Kao,David
中科院分区：
文献类型：
--
作者：
Venechuk,GraceE;Khazanie,Prateeti;Page2nd,RobertL;Knoepke,ChristopherE;Helmkamp,LauraJ;Peterson,PamelaN;Pierce,Kenneth;Thompson,JocelynS;Huang,Janice;Strader,JamesR;Dow,TristanJ;Richards,Lance;Trinkley,KatyE;Kao,David
背景射血分数降低的心力衰竭（HFrEF）可从多种药物治疗的启动和强化中获益。不幸的是，这些药物的常规使用存在重大差距。如果没有新的方法来改善处方，HFrEF治疗的累积获益将在很大程度上无法实现。直接面向消费者的营销和共同决策反映了这样一种文化，即患者越来越多地参与治疗选择，从而为患者参与的处方干预创造了机会。假设鼓励患者参与HFrEF处方决策的提供者将改善指南指导的医疗治疗的使用。设计电子交付，射血分数降低心力衰竭慢性药物强化治疗的患者激活工具（EPIC-HF）试验将HFrEF患者随机分配至常规治疗组与患者激活工具组-a 3-在心脏病诊所就诊前提供一分钟视频和一页清单，鼓励患者与其临床医生合作，加强HFrEF处方。该研究评估了EPIC-HF干预措施在交付后一个月内改善指南导向的药物治疗的有效性，同时使用实施设计来了解该方法在现实世界护理交付背景下的覆盖、采用、实施和维护。研究入组于2020年1月完成，共有305例患者。基线数据显示了显著的机会，<1%的患者接受最佳HFrEF药物治疗。如果成功，该工具可以很容易地传播，并可以为其他慢性病的类似干预措施提供信息。
BackgroundHeart failure with reduced ejection fraction (HFrEF) benefits from initiation and intensification of multiple pharmacotherapies. Unfortunately, there are major gaps in the routine use of these drugs. Without novel approaches to improve prescribing, the cumulative benefits of HFrEF treatment will be largely unrealized. Direct-to-consumer marketing and shared decision making reflect a culture where patients are increasingly involved in treatment choices, creating opportunities for prescribing interventions that engage patients.HypothesisEncouraging patients to engage providers in HFrEF prescribing decisions will improve the use of guideline-directed medical therapies.DesignThe Electronically delivered, Patient-activation tool for Intensification of Chronic medications for Heart Failure with reduced ejection fraction (EPIC-HF) trial randomizes patients with HFrEF to usual care versus patient-activation tools—a 3-minute video and 1-page checklist—delivered prior to cardiology clinic visits that encourage patients to work collaboratively with their clinicians to intensify HFrEF prescribing. The study assesses the effectiveness of the EPIC-HF intervention to improve guideline-directed medical therapy in the month after its delivery while using an implementation design to also understand the reach, adoption, implementation, and maintenance of this approach within the context of real-world care delivery. Study enrollment was completed in January 2020, with a total 305 patients. Baseline data revealed significant opportunities, with <1% of patients on optimal HFrEF medical therapy.SummaryThe EPIC-HF trial assesses the implementation, effectiveness, and safety of patient engagement in HFrEF prescribing decisions. If successful, the tool can be easily disseminated and may inform similar interventions for other chronic conditions.