The epidemiology of heart failure (HF) is changing. This study aimed to describe questions that arise during the routine care of HF patients that are unanswered by the current literature and describe how the type and focus of these questions has changed over time.
Investigators from the National Heart, Lung, and Blood Institute–sponsored Heart Failure Apprentice Network collected and categorized questions from 5 academic hospitals over 12 months. A total of 174 unanswered questions were collected and analyzed.
Compared with 2004, there were more unanswered questions about “whether” to use therapies and fewer about “how” to use therapies. There were fewer questions about what therapeutic targets, therapy adjustment, and combination therapies. There were more questions about whether or how to stop therapies and how to add therapies back. Newly prominent topics, not observed in 2004, including novel therapeutics, refractory ventricular tachycardia, right heart failure, and nutrition/frailty, accounted for 24% of questions.
Compared with 2004, there are fewer unanswered questions about how to use, adjust, and combine therapies. There were more unanswered questions about whether and how to stop therapies. Almost 25% of unanswered questions dealt with topics indicative of more advanced disease which were not observed in 2004.
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- Searching for evidence: refractory questions in advanced heart failure.J Card Fail. 2004; 10: 210-218
- Diuretic strategies in patients with acute decompensated heart failure.N Engl J Med. 2011; 364: 797-805
- Ultrafiltration in decompensated heart failure with cardiorenal syndrome.N Engl J Med. 2012; 367: 2296-2304
- Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: the ROSE Acute Heart Failure randomized trial.JAMA. 2013; 310: 2533-2543
- Differential response to low-dose dopamine or low-dose nesiritide in acute heart failure with reduced or preserved ejection fraction: results from the ROSE AHF trial (Renal Optimization Strategies Evaluation in Acute Heart Failure).Circ Heart Fail. 2016; 9
- Heart failure fact sheet.(Available at:)
- A call for collaboration: the evolving heart failure apprenticeship network.J Am Coll Cardiol. 2015; 65: 2348-2351
- Association between the Value-Based Purchasing pay for performance program and patient mortality in US hospitals: observational study.BMJ. 2016; 353: i2214
- Comparison of Sacubitril/Valsartan Versus Enalapril on Effect on ntpRo-bnp in Patients Stabilized From an Acute Heart Failure Episode (PIONEER-HF).(ClinicalTrials.gov; Available at:)
- Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs.N Engl J Med. 2016; 375: 111-121
- Characteristics of ventricular tachycardia ablation in patients with continuous flow left ventricular assist devices.Circ Arrhythm Electrophysiol. 2015; 8: 592-597
- The use of diuretics in acute heart failure: evidence based therapy?.World J Cardiovasc Dis. 2013; 3: 30887
- The successful use of phosphodiesterase type 5 inhibitors to treat the syndrome of cor pulmonale and prerenal azotemia with diuresis of anasarca (CorPRADA).South Med J. 2010; 103: 116-120
- Frailty in heart failure.Curr Heart Fail Rep. 2014; 11: 266-273
- The older patient with heart failure: high risk for frailty and cognitive impairment.Expert Rev Cardiovasc Ther. 2012; 10: 779-795
- Frailty in advanced heart failure: a systematic review.Heart Fail Rev. 2015; 20: 553-560
Published online: July 06, 2017
Accepted: June 30, 2017
Received in revised form: June 6, 2017
Received: March 3, 2017
Funding: National Heart, Lung, and Blood Institute Heart Failure Network training grant (NIH/NHLBI U01HL084877).
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