Clinical inertia in the treatment of heart failure: a major issue to tackle

C. Verhestraeten, W.A. Heggermont, M. Maris*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

12 Citations (Web of Science)

Abstract

Despite an enormous improvement in heart failure management during the last decades, the hospitalization and mortality rate of heart failure patients still remain very high. Clinical inertia, defined as the lack of treatment intensification in a patient not at evidence-based goals for care, is an important underlying cause. Clinical inertia is extensively described in hypertension and type 2 diabetes mellitus, but increasingly recognized in heart failure as well. Given the well-established guidelines for the management of heart failure, these are still not being reflected in clinical practice. While the absolute majority of patients were treated by guideline-directed heart failure drugs, only a small percentage of these patients reached the correct guideline-recommended target dose of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, mineralocorticoid receptor antagonists, and angiotensin receptor-neprilysin inhibitors. This considerable under-treatment leads to a large number of avoidable hospitalizations and deaths. This review discusses clinical inertia in heart failure and explains its major contributing factors (i.e., physician, patient, and system) and touches upon some recommendations to prevent clinical inertia and ameliorate heart failure treatment.
Original languageEnglish
Pages (from-to)1359-1370
Number of pages12
JournalHeart Failure Reviews
Volume26
Issue number6
Early online date30 May 2020
DOIs
Publication statusPublished - Nov 2021

Keywords

  • Clinical inertia
  • Guideline-directed treatment
  • Heart failure
  • Target dose
  • Under-treatment
  • REDUCED EJECTION FRACTION
  • QUALITY-OF-CARE
  • TREATMENT GUIDELINES
  • SURVEY PROGRAM
  • ADHERENCE
  • THERAPY
  • EUROPE
  • UPTITRATION
  • MANAGEMENT
  • CARDIOLOGY

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