Heart failure & cardiomyopathies
Clinical Inertia Among Outpatients With Heart Failure: Application of Treatment Nonintensification Taxonomy to EPIC-HF Trial
Authors' conclusion
In this comprehensive study exploring HFrEF prescribing, clinical inertia is a main contributor to nonintensification within an updated taxonomy classification for suboptimal GDMT prescribing.
Study context
- Population
- Outpatients with heart failure with reduced ejection fraction (HFrEF) who completed a cardiology visit32 audio recordings analysed
- Participants
- 292 outpatients
- Primary endpoint
- Reasons for guideline-directed medical therapy (GDMT) nonintensification and clinical inertia
Methodological detailssequential, explanatory mixed-methods study, structured chart reviews, qualitative analysis of clinic audio recordings
- Sequential, explanatory mixed-methods study
- Structured chart reviews
- Qualitative analysis of clinic audio recordings
Primary result
As reported in the abstract
No treatment intensification
185
63.4%
Clinical inertia (≥1 opportunity for intensification without documented contraindication or barriers), among nonintensified
90
48.6%
Further findings
Nonintensification reasons, by medication class
- Heightened risk of adverse effects
- range 18.2%-31.6%
- Patient nonadherence
- range 0.8%-1.1%
- Patient preferences and beliefs
- range 0.6%-0.9%
- Comanagement with other providers
- range 4.6%-5.6%
- Prioritization of other issues
- range 15.6%-31.8%
- Multiple categories
- range 16.5%-22.7%
- Clinical inertia
- range 22.7%-31.6%
Characteristics of clinical inertia (qualitative, 32 clinic audio recordings)
- Clinician review of medication regimens without education or intensification discussions
- Patient stability as justification for nonintensification
- Shorter encounters for nonintensification vs intensification
Original publication
Clinical Inertia Among Outpatients With Heart Failure: Application of Treatment Nonintensification Taxonomy to EPIC-HF Trial. JACC Heart Fail. Published 16 August 2023. doi:10.
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