Primary care Adherence to Heart failure guidelines in post-discharge, evaluation & routine management (PATHFINDER): a randomized controlled trial

BACKGROUND AND AIMS: Heart failure (HF) management guidelines offer evidence-based recommendations but can be difficult to implement in primary care. This randomized controlled trial evaluated a multifaceted intervention to improve adherence to pharmacological and nonpharmacological HF management guidelines in primary care. METHODS AND RESULTS: Patients hospitalized with HF were randomized 1:1 to an intervention or control group. The intervention group received guideline-based inpatient education, a postdischarge plan including referral to cardiac rehabilitation (CR) and scheduled general practitioner follow-ups at 1 and 4 weeks, and 3 months, supported by a cardiologist-approved medication titration plan. The control group received usual care. The primary outcome, measured at 6 months, was adherence to five recommended treatments: (i) ACEI/ARB/ARNI ≥50% target dose, (ii) beta blocker ≥50% target dose, (iii) MRA at any dose, (iv) anticoagulation for atrial fibrillation, and (v) CR referral. Adherence was compared using chi-squared tests and logistic regression.Of 225 participants (25% female), a greater proportion in the intervention group achieved the primary outcome (61.8% vs. 28.7%; P < .01). The unadjusted odds ratio showed that the intervention group was 6.27 times more likely to achieve the outcome compared to the control group (95% confidence interval [CI], 3.35-11.76, P < .01). This difference was driven by higher prescription rates of ACEI/ARB/ARNI and beta blocker, and higher referral rates to CR. CONCLUSION: Hospital-based support for HF-management in primary care improved adherence to pharmacological and non-pharmacological components of guideline-recommended care. Greater implementation of transitional care processes of this nature has the potential to improve clinical outcomes for patients with HF.