Identifying the unmet needs of patients with heart failure

Ryan Hamschild, PharmD, MSc, MBA: Thank you all for this rich and informative discussion. Before we wrap up, I’d like to get the final thoughts from each of you. Dr. Murillo, can we start with you on your final thoughts for our audience?

Jaime Murillo, MD: Yes, and thanks for the opportunity to discuss a population health approach to the management of heart failure, a critical group of patients for us. If you think about the US population, the fact that more than 50% of the population is theoretically at risk of heart failure puts a huge burden on us to move downstream. Now is the time to start thinking about the best way to treat heart failure through targeted medical therapy, and how we can be more proactive and identify those at risk for heart failure and those who are pre-hearted as disgraced. Can we improve strategies to identify those patients who get better tests? What are the population groups at risk? How can we make better use of our data to risk stratifying patients in a better way to prevent them from entering stage D heart failure?

It is more necessary and vital for us to treat heart failure in the most optimal way than we have so far, beyond the purely clinical considerations of treating heart failure. The key to our success is how we see the patient in their own environment and how we can treat that patient with their own needs outside of prescriptions.

Ryan Hamschild, PharmD, MSc, MBA: Excellent idea: risk stratification, early detection, and team-based care. Dr. Anderson, your last thoughts for us?

John E. Anderson, MD: Thanks. This was a great discussion. When I look back at the trajectory of my career where we started and where we are now with heart failure, we have the embarrassment of almost a fortune in terms of tools and treatments we never had before. But this also comes with increased complexity, particularly in the world of primary care, where you manage multiple different conditions and diseases. Education is critical to making sure that everyone understands what guideline-guided therapy looks like.

Finally, we have to demolish the silos. Many patients with cardio-renal metabolism bypass all of these treatment options so that we can no longer be the one who treats only glucose or treats only blood pressure. When you enter the examination room and the patient is sitting in front of you, what do they need? What are they missing? What connections do you need to make this happen?

Ryan Hamschild, PharmD, MSc, MBA: Excellent thoughts. Dr. Opal, how would you like to end us with some of your final thoughts from today?

Rohit Uppal, MD, MBA, SFH: These are great final ideas. People stole my ideas, too. It’s unbelievable how many times team-based sponsorship and smashing silos have appeared today. Here we are on a call where we have a pharmacist facilitating a conversation that includes a primary care physician, a hospital, and a cardiologist. These are the kinds of conversations we need to have. In the course of this conversation, we have covered a lot of ground and made a lot of progress. We need to have these kinds of conversations at the community and hospital level. This is how we break down those silos. I am glad to be a part of this. Thank you.

Ryan Hamschild, PharmD, MSc, MBA: Thank you. And Dr. Ganuzzi, we want to leave with some final thoughts from you.

Jim Ganuzzi, MD: There is nothing else to say. This was a great discussion. My colleagues have covered all the important points. It is useful and important to know why we do the things we do, but it is very important to know how to do the things we do. To simplify matters, the ejection fraction has been reduced, slightly reduced, and maintained. The treatments are pretty much the same across those different categories. Most important is how to start treatment, how to titrate medications, work as a team, and learn how to use these medications. Because with the rising tide of heart failure in the healthcare system, everything is within reach. Everyone needs to know how to use and apply these treatments effectively in order to reduce risks to our patients.

Ryan Hamschild, PharmD, MSc, MBA: Thank you all again for this wonderful discussion. And for our fans, we hope you found this one AJMC® Peer exchange The discussion should be useful and informative.

Text has been edited for clarity.