Improving diagnosis of heart failure with preserved ejection fraction in primary care. - ABSTRACT Heart failure affects 6 million people in the US, resulting on 1 million hospitalizations and a cost of over $30 billion per year. Heart failure with preserved election fraction (HFpEF) accounts for half of these cases, and its prevalence is rising by 1% annually. About 20-30% of HFpEF cases remain undiagnosed, contributing to poor health outcomes for these patients. Preliminary data suggest that primary care providers (PCPs) are often unaware of diagnostic and treatment guidelines for HFpEF. At the same time, primary care has an invaluable potential to improve HFpEF health outcomes by facilitating early diagnosis, referral to cardiology, and treating HFpEF comorbidities. The objective of this proposal is to design and test a novel intervention that will educate PCPs about HFpEF and provide them with a clinical diagnostic decision support aide (CDDSA) that is based on a validated diagnostic score for HFpEF. The overall hypothesis of this project is that if PCPs can detect HFpEF earlier, and therefore, refer patients to cardiology, and manage their comorbidities, it can help improve outcomes in HFpEF. Building on established community-academic collaborations, this project will be conducted with the help of the Alabama Practice-Based Research Network (APBRN). This project will include identification of provider barriers to HFpEF diagnosis among PCPs via an interview and a survey that will measure the prevalence of HFpEF knowledge gaps and preferences for an intervention (Aim 1); a stakeholder-engaged process to design an educational session and CDDSA to optimize HFpEF diagnosis in primary care (Aim 2); and a pilot study to test the feasibility and acceptability of the CDDSA (Aim 3). At the completion of the pilot study in Aim 3, the intervention will be ready to be tested at a larger scale (e.g., R-series grant) to evaluate its efficacy. The candidate for this career development award, Yulia Khodneva, MD, PhD, is a general internist with expertise in clinical medicine, epidemiology, and health services research. This award will enable her to gain skills necessary for her transition to independence focusing her research on improving healthcare delivery, and outcomes for HFpEF patients. Specifically, Dr. Khodneva will receive training in intervention development, implementation science, and conducting of pragmatic clinical trials, designed to improve healthcare delivery and outcomes for HFpEF patients. Dr. Khodneva will be mentored by two NHLBI-funded physician- investigators, Andrea Cherrington, MD (primary mentor; expert in intervention development and pragmatic clinical trials), Pankaj Arora, MD, (co-mentor; expert in HFpEF diagnosis and HFpEF echocardiography), and Larry Hearld, PhD (co-mentor; expert in implementation science). The combination of mentorship, formal coursework, and the proposed experiential learning during the project’s 5-year integrated training and research plan will position Dr. Khodneva to become an independent investigator while advancing the field of primary care for HFpEF patients.
