Proactive Panel Management Clinics for HFrEF for Heart Failure

Phase-Based Progress Estimates
1
Effectiveness
1
Safety
VA West Los Angeles, Los Angeles, CA
Heart Failure+1 More
Proactive Panel Management Clinics for HFrEF - Other
Eligibility
18+
All Sexes
Eligible conditions
Select

Study Summary

This study is evaluating whether a set of activities can improve heart failure treatment in people with heart failure.

See full description

Eligible Conditions

  • Heart Failure
  • Hearth Failure With Reduced Ejection Fraction (HFrEF)

Treatment Effectiveness

Effectiveness Estimate

1 of 3

Compared to trials

Study Objectives

This trial is evaluating whether Proactive Panel Management Clinics for HFrEF will improve 1 primary outcome, 7 secondary outcomes, and 3 other outcomes in patients with Heart Failure. Measurement will happen over the course of At baseline with no comparison group.

6-months
Change in Total Deaths
Change in Total Hospitalizations
6-months after all patients receive the intervention
Change in proportion receiving ACE/ARB/ARNI
Change in proportion receiving ARNI
Change in proportion receiving MRA
Change in proportion receiving SGLT2i
Change in proportion receiving beta-blockers
Optimization Potential Score
At baseline with no comparison group
Qualitative analysis of patient satisfaction
At baseline, no comparison
Health Service Efficiency
Baseline, no comparison
Clinician time per patient

Trial Safety

Safety Estimate

1 of 3

Compared to trials

Trial Design

2 Treatment Groups

Usual Care
1 of 2
Intervention
1 of 2
Active Control
Experimental Treatment

This trial requires 300 total participants across 2 different treatment groups

This trial involves 2 different treatments. Proactive Panel Management Clinics For HFrEF is the primary treatment being studied. Participants will all receive the same treatment. There is no placebo group. The treatments being tested are not being studied for commercial purposes.

Intervention
Other
Patients with perceived gaps in performance measures for guideline-directed medical therapies for heart failure with reduced ejection fraction will be chart-reviewed and called impromptu to receive point of care medication titration or reintegration into routine heart failure clinic. Patients lost to follow-up may be better identified using the HFrEF panel management tools.
Usual CareA control group of patients with HFrEF will receive routine primary and cardiology care as currently indicated in routine scheduled clinic grids. Patients are at the discretion of their primary care and cardiology clinicians regarding whether further HFrEF optimization is warranted. While panel management data is available to all clinicians, clinical workflows and responsibilities do not encourage the use of panel data or response to performance measurement for HFrEF.

Trial Logistics

Trial Timeline

Approximate Timeline
Screening: ~3 weeks
Treatment: Varies
Reporting: 6-months
This trial has the following approximate timeline: 3 weeks for initial screening, variable treatment timelines, and roughly 6-months for reporting.

Who is running the study

Principal Investigator
B. Z.
Boback Ziaeian, Staff Cardiologist
VA Greater Los Angeles Healthcare System

Closest Location

VA West Los Angeles - Los Angeles, CA

Eligibility Criteria

This trial is for patients born any sex aged 18 and older. There are 9 eligibility criteria to participate in this trial as listed below.

Mark “yes” if the following statements are true for you:
The patient doesn't have an active prescription for a beta-blocker, ACE/ARB/ARNI, MRA, or SGLT2i. show original
There are no appointments for heart failure or primary care in the next 2 weeks. show original
in a sitting position The patient has a blood pressure of over 90 mm Hg in a sitting position. show original
/1.73 m2 The patient's estimated GFR is greater than or equal to 30 mL/min/1.73 m2. show original
.0 mmol/L The patient has a documented potassium level of less than 5.0 mmol/L. show original
The patient is 18 years old or older. show original
Division: West LA VAMC
The Greater Los Angeles area is home to many great facilities show original
Patients have a heart condition that is making their left ventricle pump less forcefully show original

Patient Q&A Section

What is heart failure?

"heart failure affects 1 in 6 adults and is the leading cause of hospitalization in Canada. By improving our knowledge about heart failure, we can better improve the outcomes for both individuals and the Canadian health care system." - Anonymous Online Contributor

Unverified Answer

How many people get heart failure a year in the United States?

"More than 1.4 million people are diagnosed with heart failure daily in the United States. This number of cases has climbed by over 15% from 1997 to 2005. Furthermore, heart failure is the leading cause of hospitalization in the United States. Patients with heart failure continue to have significant long-term health risks. Given these findings, more effective efforts are needed to improve early detection, diagnosis, and intervention of heart failure." - Anonymous Online Contributor

Unverified Answer

What causes heart failure?

"heart failure results from the progressive deterioration of the heart due to its inability to maintain adequate blood flow. Understanding what causes heart failure can help patients manage the disease and reduce its impact." - Anonymous Online Contributor

Unverified Answer

What are the signs of heart failure?

"It's not obvious when the deterioration of heart failure becomes severe. The main sign is fatigue and palpitations. The physical exam will show edema and swollen ankles and elbows. The patient will feel short of breath that sounds like crackling when the heart beats. Later on, the person may see bubbles in the skin on the lower abdomen. The lower left leg may feel swollen, cold on the outside, and warm and wet on the inside. Sometimes the patient may have a sense of losing control. The heart rate will be slow and may change during the day. The person may not be able to feel their pulse from the wrist or the neck as it hurts from the heart squeezing." - Anonymous Online Contributor

Unverified Answer

Can heart failure be cured?

"Symptoms are improved in half of the patients, especially those with HF of moderate to severe severity. HF is likely to be curable only if severe disease such as refractory shock or refractory heart failure is avoided. The risk of sudden death in those with HF may be lowered if medication is improved or if patients are monitored for cardiovascular disease." - Anonymous Online Contributor

Unverified Answer

What are common treatments for heart failure?

"Patients with heart failure are treated with many medications. Some of these are commonly used in other conditions. However many patients with heart failure also suffer from other illnesses which might complicate the management of their illness and may limit their ability to access all of the potential benefits. What are the common treatments for heart failure? answer: Cardiac surgery may be beneficial to some congestive heart failure patients. However, the risks of surgery need to be balanced against the benefit of surgery." - Anonymous Online Contributor

Unverified Answer

What is the latest research for heart failure?

"While many articles were published, they did not appear to review recent articles. Inclusion of recent articles could have improved our understanding of the natural course of the disease." - Anonymous Online Contributor

Unverified Answer

Is proactive panel management clinics for hfref typically used in combination with any other treatments?

"Proactive panel management at an HF clinic had a negative impact on the receipt of appropriate HF treatments, particularly for patients with mild to moderate heart failure. A more proactive HF treatment approach may improve outcomes." - Anonymous Online Contributor

Unverified Answer

What are the latest developments in proactive panel management clinics for hfref for therapeutic use?

"The current 'ad hoc' approach to assessing and treating patients with heart failure at the panel clinic appears to be efficacious in managing cardiovascular risk in individuals with HFrEF. Patients enrolled in the PROMISE Trial were managed in a structured fashion within the proactive panel. We discuss the PROMISE Trial data and its implications for clinical practice." - Anonymous Online Contributor

Unverified Answer

Have there been other clinical trials involving proactive panel management clinics for hfref?

"Patients with symptoms of heart failure and a relatively preserved ejection fraction were identified by the proactive care clinic and were followed over 12 months. The management recommendations of proactive care did not lead to a sustained improvement in heart failure symptoms." - Anonymous Online Contributor

Unverified Answer

How serious can heart failure be?

"About two-thirds of patients with heart failure have some degree of exertional limitation while only about 10% are unable to perform regular activities of daily living when heart failure symptoms occur. Cardiac patients with worse symptoms or more physical disability are at greater risk for dying than patients with milder symptoms or worse disability. Therefore, heart failure is not a benign condition when the symptoms are mild, though heart failure usually progresses regardless of symptom severity or disability. Most patients with heart failure have signs of a coronary artery disease but asymptomatic disease is surprisingly common among this population. If a patient has heart failure, we should consider excluding chest pain or other potential signs of coronary disease." - Anonymous Online Contributor

Unverified Answer

Who should consider clinical trials for heart failure?

"In this analysis, women with a baseline NT-proBNP >1000 pmol/liter were 3.5 to 3 fold more likely to be enrolled in a trial than men, and were also less likely to have LV reversiventure on the study completion. These differences suggest potential for bias in trial enrollment of women with systolic HF and also suggest gender differences in clinical trial recruitment." - Anonymous Online Contributor

Unverified Answer
Please Note: These questions and answers are submitted by anonymous patients, and have not been verified by our internal team.
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