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Optimizing Medical Therapy for Chronic Heart Failure

Curriculum

THE PROBLEM
Intractable. Success in treating 6 million patients in America with heart failure (HF) is limited, as the medical community has not yet embraced new guidelines and best practices on optimal medical therapy (OMT) for chronic HF.
THE GOAL
Simple. To reduce the performance variation by clinicians when prescribing OMT for chronic HF, reduce hospitalizations and readmissions, and forge a partnership with patients and caregivers to enhance self-care strategies.
OUR EDUCATION
Comprehensive. Three steps comprise the curriculum: Learn. Online videos review foundational precepts. Practice. Live meetings sharpen your skills. Perform. Activities and after-education coaching reinforce the lessons learned.

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Expert Perspectives (Online Videos)
0.50 CME/CNE CREDITS EACH
OVERVIEW +

Chronic Heart Failure: Stretching Care
Beyond Its Limits

Akshay Desai, MD, MPH
Show Description
0.50 / AMA PRA Category 1 CreditTM
0.50 / CNE Contact Hour

Despite great progress in improving outcomes in other cardiovascular diseases (eg, acute coronary syndrome/myocardial infarction), we have seen limited success in heart failure prevention and management for a variety of reasons that include inadequate or inappropriate optimal medical therapy. While other variables such as initial hospitalization rates are declining in the United States, post-discharge mortality and readmission rates remain stable and may be trending upward, despite a multifaceted approach to after-hospitalization management.

Reduced versus Preserved:
The Heart Classification that Matters

Biykem Bozkurt, MD, PhD
Lee Goldberg, MD, MPH
Show Description
0.50 / AMA PRA Category 1 CreditTM
0.50 / CNE Contact Hour

Classifying patients with heart failure (HF) according to type of cardiac dysfunction—reduced (r) or preserved (p) ejection fraction (EF)—provides a well-defined patient population. HFrEF and HFpEF have different pathophysiologiesthat require different treatment approaches. Approximately 60% of all HF cases are thought to be systolic or HFrEF, and the remainder are classified as HFpEF. In HFrEF, reduced left ventricular systolic function leads to a decreased EF and cardiac output, resulting in decreased systemic perfusion.

Guideline-Directed Pharmacologic Treatment of Chronic HF: The First Step to Improved Care

Lee Goldberg, MD, MPH
Show Description
Studies show that for patients with heart failure (HF) there is inadequate use of guideline-recommended optimal medical therapy (OMT)—such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) in appropriate HF patients—coupled with inadequate patient education on disease self-management. Beta-blockers (BBs) and aldosterone antagonists are especially underused, as are implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) ICDs. Education is also needed on uptitration recommendations.

Guideline-Driven Game Changers:
Integrating Sacubitril/Valsartan into Practice

Biykem Bozkurt, MD, PhD
Lee Goldberg, MD, MPH
Show Description
In 2015, the US Food and Drug Administration (FDA) approved sacubitril/valsartan, making it one of the first pharmacologic therapies to emerge for chronic heart failure (HF) management in more than a decade. In the key pre-approval study, sacubitril/valsartan treatment was associated with a 20% reduction in the combined primary end point of death or HF hospitalization and a 16% reduction in all-cause death compared with enalapril. This activity explores how to incorporate sacubitril/valsartan into treatment planning for chronic HF.

Guideline-Driven Game Changers:
Integrating Ivabradine Into Practice

Biykem Bozkurt, MD, PhD
Lee Goldberg, MD, MPH
Show Description
In 2015, the US Food and Drug Administration (FDA) approved ivabradine making, it one of the first pharmacologic therapies to emerge for chronic heart failure (HF) management in more than a decade. The key pre-approval study found an 18% relative risk reduction for the primary outcome of cardiovascular death or hospital admission for worsening HF. Additional analyses found a reduced risk of hospitalization, reverse remodeling, and improved quality of life with ivabradine compared with placebo.

Chronic HF Hospitalization and
Reducing Readmissions

Akshay Desai, MD, MPH
Show Description

Understanding Heart Failure
Core Measures: Got Data?

Cathleen Biga, RN, MSN
Show Description
Starting in 2019, there will be 2 pathways to clinician payment: the Merit-based Incentive Payment System (MIPS) or participation in eligible Alternative Payment Models (APMs). The MIPS allows Medicare clinicians to be paid for providing high-value care through success in 4 performance categories: quality, advancing care information, clinical practice improvement activities, and cost. The 4 categories will likely utilize quality measures already in place under the existing Medicare quality reporting programs.
Viewpoints in Heart Failure (E-Articles)
0.50 CME/CNE CREDITS EACH
OVERVIEW +

Heart Failure Nation: Taking a Hard Look at Implications

Marc A. Silver, MD, FACP, FACC, FAHA, FHFSA
Show Description
0.50 / AMA PRA Category 1 CreditTM
0.50 / CNE Contact Hour

Despite all the progress and investments made in the awareness, prevention, detection, and treatment of heart failure (HF) in the United States, hospital readmissions still occur all too often. In this “Viewpoint” article, Dr. Marc Silver considers ways in which our current approach to care delivery fails to produce optimal outcomes and offers some observations on how healthcare providers can act to curb the associated morbidity and mortality in this vulnerable patient population as well as alleviate the consequent financial strain to hospitals, payers, other stakeholders, and society at large.

The Impact of HFrEF vs HFpEF: How Do We Measure Up?

Marc A. Silver, MD, FACP, FACC, FAHA, FHFSA
Show Description
0.50 / AMA PRA Category 1 CreditTM
0.50 / CNE Contact Hour

In this “Viewpoint” article, Dr. Marc Silver reviews heart failure (HF) phenotypes, with a particular emphasis on HF patients whose left ventricular ejection fractions fall into the midrange between reduced and preserved (ie, 40% to 50%), as well as a proposed classification system that incorporates the genetics of HF.

Falling Short on Simple Guideline-Directed Care for Heart Failure

William G. Cotts, MD, MS FACP, FACC, FAHA
Coming Soon
Studies show that for patients with heart failure (HF) there is inadequate use of guideline-recommended optimal medical therapy (OMT)—such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) in appropriate HF patients—coupled with inadequate patient education on disease self-management. Beta-blockers (BBs) and aldosterone antagonists are especially underused, as are implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) ICDs. Education is also needed on uptitration recommendations.

Sacubitril/Valsartan: A Game Changer in HF Treatment

John G. Furiasse, MD, FACC
Coming Soon

Ivabradine: A Game Changer in
HF Treatment

John G. Furiasse, MD, FACC
Coming Soon

Interrupting the Revolving Door of HF Hospitalization and Readmission

Marc A. Silver, MD, FACP, FACC, FAHA, FHFSA
Coming Soon

Leveraging the Quality Payment Program to Optimize Heart Failure Care

Faculty information coming soon
Coming Soon
Special Considerations for Women and Communities of Color: Monologues to Dialogues​​ (Online Videos)
1.00 CME/CNE CREDIT EACH
OVERVIEW +

Chronic Heart Failure: Stretching Care
Case: A 63-Year-Old Female HF Patient Recently Diagnosed With HFpEF

Biykem Bozkurt, MD, PhD
Akshay Desai, MD, MPH
Lee Goldberg, MD, MPH
Show Description

Case: A 42-Year-Old African American Man
With HF Recently Discharged From the Hospital

Michelle Johnson, MD
Eldrin Foster Lewis, MD, MPH
Show Description

Case: A 52-Year-Old Native American Woman With HFrEF

Carlos J. Rodriguez-Reyes, MD, MPH, FACC, FAHA
Dena Wilson, MD, FACC
Show Description

Case: A 59-Year-Old Hispanic Man with HF and Multiple Comorbidities: A Caregiver's Perspective

Carlos J. Rodriguez-Reyes, MD, MPH, FACC, FAHA
Dena Wilson, MD, FACC
Show Description
Live Meetings
2.00 CME/CNE credits each
OVERVIEW +

Lessons for the Front Line: How to Reduce Performance Variation in Chronic HF Management—
Regional Community Hospitals

Cathleen Biga, RN, MSN
Akshay Desai, MD, MPH
A 2-hour interactive live session that puts into practice the lessons learned from other activities in the curriculum. These hands-on sessions will take place in regional community hospitals--full details on dates and locations coming soon. Give us your email and we will notify you as soon as dates and locations are set.


Lessons for the Front Line: How to Reduce Performance Variation in Chronic HF Management—
Veterans Administration Hospitals

Cathleen Biga, RN, MSN
Akshay Desai, MD, MPH
A 2-hour interactive live session that puts into practice the lessons learned from all previous curricula. These sessions will take place in VA hospitals. Concurrent, 90-minute sessions for the patient and caregiver will cover issues such as nutritional coaching and self-care. Full details on dates and locations coming soon. Give us your email and we will notify you as soon as dates and locations are set.

Reinforcing Activities (Online Video/Article/After-Education Program)
1.00 CME/CNE credit each
OVERVIEW +

Lessons for the Front Line: How to Reduce Performance Variation in Chronic HF Management


This online video will capture one of the live meetings described above.
Coming Soon

Concerns and Controversies over New Treatments in Chronic HF


A provocative point-counterpoint discussion article on key chronic HF issues available in both print and online.
Coming Soon

Coaching for Performance Improvement (CoPI)
(A Clinical Performance Improvement Online Activity)
Partner with the American College of Cardiology for the Coaching for Performance Improvement (CoPI) after-education program, an asynchronous online learning experience. We will challenge you to strengthen your prescribing practices through reinforcing activities, reviewable resources and social interaction with peers and Heart Failure Performance Improvement (HFPI) coaches.
Activities
Chalk Talk
Listen as HFPI coaches review strategies that will enhance your prescribing practices.
Coffee and Cases
Evaluate case-based scenarios on-the-go or at home in this CME credit activity.
Resources
Pocket Partner
Track your progression using a step-wise guide and additional resources to improve OMT.
Coaching
#HFPITalk
Converse with peers to network, catch up on current news, and connect on shared goals.
Virtual Office Hours
Interact with HFPI coaches by posting questions and receiving same-day feedback.