Digital Health and Implementation Science Virtual Symposium

We need to remain concerned and vigilant about addressing burnout for all stakeholders, including physicians along with advanced practitioners, nurses and support staff. The key is ensuring each member of the team is working to the top of his/her license. Physicians can be readily assisted by advanced practitioners when implementing clear GDMT titration protocols. Nurses can help organize protocols for follow-up labs, blood pressure monitoring, prior authorization processes in partnership with pharmacists and medical assistants. Automating predictably duplicable processes is really part of the key reducing burnout for the team members.

Primary care physicians and advanced practitioners indeed see many of our heart failure patients. We need to do a better job engaging with them with CME events and working to partner with them as they share the care of our patients. The best way for primary care team members to learn from heart failure specialists is to partner together in the shared care of a heart failure patient. This way, for instance, both parties take responsibility for initiating the SGLT2i for the patient with diabetes, chronic kidney disease, and heart failure with reduced ejection fraction. But in order to ask this of our primary care colleagues we must clearly lead by example. Evidence remains that even cardiology teams are falling significantly short of the call to action (see CHAMP-HF study data) so how can we expect primary care to take on more responsibility if cardiology teams are not setting the right focus on action.

Patient empowerment is a large topic for discussion. To participate in shared decision making our clinical teams need to recognize their expertise is focused on the disease and the therapeutic options, but the patient is the expert of his/her own value system and preferences. For instance, some patients value life expectancy less than quality of life enhancements and concerns such as medication costs, polypharmacy, side effects etc mean different things to different patients. Both the clinician and the patient need to come together to bring options to the table and incorporate science, evidence, guidelines recommendations, and patient-centered values together to ultimately make the shared decision. Patients can be empowered with their own diagnostic data (such as markers of congestion identified on remote monitoring devices or on labs such as natriuretic peptides) and through access to their own medical records and studies in the EMR. Patients can also be educated on best practices and options for therapies such as what was demonstrated in EPIC-HF study. Ultimately, there is much room for expanding patient empowerment to optimize outcomes that are of most interest to patients.