The need for an optimal care pathway: the case of heart failure patients

Although heart failure currently affects 1,500,000 French people and has a high mortality rate, with 25% of deaths following an acute event of cardiac decompensation, its management is not optimal. 50% of heart failure patients are rehospitalized within one year. 64% of these hospitalizations could be avoided, saving approximately 836 million euros. First line treatments and second line treatments that will soon be available, associated with the implementation of hygiene-dietary recommendations, have shown their effectiveness.  It is therefore an unmet organizational need that causes the misuse of these treatments and recommendations to the detriment of patients, healthcare system, and pharmaceutical companies offering treatments for heart failure. In this context, Alcimed investigates for you, the subjacent causes of these dysfunctions and the reasons for the pharmaceutical industry to act.

Heart failure: a patient pathway punctuated by difficulties, with a considerable impact on the patient’s health

Heart failure is often diagnosed during an exacerbation of the disease, leading patients to emergency, despite warning signs (EPOFs) that should allow it to be detected during the chronic phase to be then managed in the city.

In France, approximately 50% of heart failure patients are not diagnosed, due to a poor knowledge of EPOFs signs and due the fact that they are managed by city practitioners who are not heart failure specialist and are not equipped to detect this pathology, which is often surrounded with many co-morbidities.

During diagnosis or due to deterioration of the patient’s health, the move to overcrowded emergency room could lead to the patient to be referred to a non-adapted hospital department. For example, an elderly patient with heart failure is often referred to the geriatric service where he or she is unlikely to see a cardiologist.

This heterogeneity is particularly reflected in the exams carried out and the treatment prescribed (medication typology and dosage), resulting in the discharge of half of the patients without the recommended treatments each year.

Regardless of the hospital service, it is recommended to support the patient on discharge. However, 46% of heart failure patients leave the hospital without being aware of their diagnosis.

In addition, the use of therapeutic education programs remains limited, given the high average age of patients and their many co-morbidities. Without a good understanding of the pathology, treatments, and hygiene-dietary rules, 30 to 50% of diagnosed heart failure patients are estimated to not take their treatment.

Finally, after discharge, during the chronic phase, the patient’s treatment should be regularly re-evaluated in order to adapt the dose or the line of treatment as soon as necessary to avoid further exacerbations of the pathology. Once again, as city practitioners are not specialized in heart failure and management is not multidisciplinary, 90% of treated patients for heart failure do not have any reassessment of their treatment.

Organizational issues which are positioned all along the heart failure patient pathway differ at the local level. They require the implementation of a tailor-made approach to ensure good prioritization of the stakes and to address the most specific ones, making a centralized national action not very effective. Pharmaceutical companies, through their capacity for coordination at the national level and their local roots, are able to support organizational innovation.

Read also: How to optimize care pathways? Essential steps and key success factors for change management

Heart failure: a common challenge between patients and pharmaceutical companies

Pharmaceutical industry stakeholders have an interest in taking this supportive position, both to promote the proper use of their products and to embody a positioning that is increasingly focused on the needs of healthcare professionals and patients.

Today, the late diagnosis of heart failure and the lack of treatment reassessment leads to an under-use of treatments.

On the one hand, patients arriving at the emergency service could have benefited from treatment, which would probably have slowed the worsening of the disease. But also, because a follow-up of heart failure patients by specialists would allow to adapt the treatment dose according the evolution of the pathology.

On the other hand, therapeutic innovations, which should benefit all those for whom they are indicated, cannot be effectively deployed without a regular assessment of worsening symptoms.

Beyond the proper use of their products, pharmaceutical companies are looking to deliver value differently to physicians and patients. Yet, these organizational issues affect the healthcare professionals’ work despite their efforts to address the medical needs of patients. Meanwhile, patients requiring care, with elderly and multi-disease profiles, are expected to become more frequent with the aging of the population. Promoting organizational innovation is therefore a concrete way for pharmaceutical companies to both support healthcare professionals and improve patients’ lives.

Heart failure is a critical case due to its high prevalence and its propensity to generate multiple hospitalizations. In many diseases, innovating to improve the patient pathway could benefit everyone: patients, healthcare professionals, the healthcare system and pharmaceutical companies. Alcimed can support you in defining and implementing these projects.

About the author
Mathilde, Consultant in Alcimed’s Healthcare team in France