Bridging Treatment Implementation Gaps in Patients With Heart Failure

Heart failure (HF) is a leading cause of death and disability in older adults. Despite decades of high-quality evidence to support their use, guideline-directed medical therapies (GDMTs) that reduce death and disease burden in HF have been suboptimally implemented. Approaches to closing care gaps have focused largely on strategies proven to be ineffective, whilst effective interventions shown to improve GDMT uptake have not been instituted. This review synthesizes implementation interventions that increase the uptake of GDMT, discusses barriers and facilitators of implementation, summarizes conceptual frameworks in implementation science that could improve knowledge uptake, and offers suggestions for trial design that could better facilitate end-of-trial implementation. We propose an evidence-to-care conceptual model that could foster the simultaneous generation of evidence and long-term implementation. By adopting principles of implementation science, policymakers, researchers, and clinicians can help reduce the burden of HF on patients and health care systems worldwide. [Display omitted] •Implementation strategies that are proven-effective in trials are underutilized in clinical settings.•Trials can better facilitate uptake of results by adopting implementation science principles in their designs.•We propose an Evidence-To-Care conceptual framework that is anchored in the health care system and supported by 4 pillars: robust trial design; equitable, sustainable, and scalable intervention; strong stakeholder engagement; and relevant outcomes.