Implementation of a Digital Patient Activation Tool to Engage Patients With Heart Failure in Intensification of Guideline-Directed Medical Therapies

Heart failure with reduced ejection fraction treatment with quadruple therapy reduces hospitalizations and improves patient survival. Despite evidence-based recommendations to initiate and up-titrate guideline-directed medical therapy to target doses, a gap remains in the achievement of target doses of guideline-directed medical therapies. Evidence-based tools have shown improvement in obtaining target doses of guideline-directed medical therapies using shared decision-making concepts, patient activation videos, and checklists. We conducted a cohort-controlled quality improvement study that aimed to evaluate a digital care platform for the implementation of shared decision-making using a digital patient activation tool, video, and checklist to achieve guideline-directed medical therapies among patients with heart failure with reduced ejection fraction discharged from a large academic medical center. In the implementation phase, 64 patients sent the patient activation video and checklist, which had successful transmission and good engagement, as compared to poor transmission and engagement in the pre-implementation cohort. Though adaptations in digital delivery processes took place throughout the implementation phase, only 26.2% of patients viewed the patient activation video at 2 weeks post-discharge. The trend in improved guideline-directed medical therapy between the pre-implementation and post-implementation cohorts was not statistically significant. Lessons learned for digital dissemination are discussed.