Abstract
BACKGROUND AND AIMS: Guideline-directed medical therapy (GDMT) for heart failure (HF) is underutilized in primary care, particularly among older adults with chronic stable HF. This prospective quality improvement study, Heart Failure in Southern Sweden (HISS), evaluated the impact of a cross-disciplinary implementation project combining cardiology and primary care expertise to enhance GDMT adherence and reduce healthcare contacts. METHODS: Twenty primary health care centres in southern Sweden participated, recruiting 587 patients diagnosed with HF (mean age 79 years) between 2021 and 2023. The intervention involved case-based educational conferences with cardiologists and general practitioners, individualized treatment recommendations, and follow-up monitoring. Medication use and healthcare contacts were assessed 6 months before and after the intervention. RESULTS: GDMT use (defined as quadruple therapy according to the 2022 guidelines) increased from 20.8% at baseline to 37.7% post-intervention (P < .001) among patients with HF with reduced ejection fraction (HFrEF), and from 12.4% to 17.8% (P = .020) among patients with mildly reduced ejection fraction (HFmrEF). The uptake of sodium-glucose co-transporter-2 inhibitors (SGLT2i) improved significantly across all HF types, while angiotensin receptor-neprilysin inhibitors (ARNI) increased among HFrEF patients. Beta-blocker use declined in patients with HF with preserved ejection fraction. The total number of ambulatory healthcare contacts decreased following the intervention, while the hospitalizations remained unchanged. CONCLUSIONS: The HISS study demonstrates that a cross-disciplinary, case-based educational intervention was associated with improved GDMT adherence (especially SGLT2i and ARNI) and reduced ambulatory healthcare utilization in primary care patients with chronic stable HF. These findings underscore the importance of bridging the gap between specialist and primary care to optimize HF management.