Registry-based research for identifying and addressing the barriers to the implementation of care in patients with heart failure

Purpose and aims. Heart failure (HF) is common and linked with poor outcome. Guideline-directed medical therapy (GDMT) improves outcome but is poorly implemented.

Barriers to implementation include limited generalizability of randomized trials, comorbidities, socioeconomic disparities, and sub-optimal HF care pathways.

We aim to evaluate 1)current use of HF therapies, 2)barriers to implementation, 3)associations of HF therapies with prognosis by trial emulation, 4)a risk score for hyperkalemia, 5)socioeconomic factors as determinants of access to HF care, 6) a registry-based screening strategy to streamline implementation.Time plan/scientific methods.

Use of and barriers to the implementation of HF therapies will be investigated in the Swedish HF Registry, where also the trials evaluating the association of HF treatments with outcomes will be emulated. SCREAM will be used to develop a risk score for hyperkalemia.

In a proof-of-concept study, SwedeHF will be screened for suboptimally treated HFrEF patients, who will be invited to an “optimization clinic”. The funding will finance the planning/design, data management, execution, and statistical analysis of the sub-projects. Ethical approval was obtained.Relevance.

Better implementation of HF GDMT can reduce the impact of HF on the society by reducing morbidity/mortality and optimizing healthcare utilisation.

Our projects foster this goal by identifying and addressing barriers to implementation by using registry-based research.