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Research ArticlePraxis

Patient decision aid for flozins in heart failure and ejection fraction greater than 40%

Blair J. MacDonald, Sheri L. Koshman and Ricky D. Turgeon
Canadian Family Physician March 2023, 69 (3) 181-185; DOI: https://doi.org/10.46747/cfp.6903181
Blair J. MacDonald
Research Coordinator in the Faculty of Pharmaceutical Sciences at the University of British Columbia in Vancouver.
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Sheri L. Koshman
Associate Professor in the Mazankowski Alberta Heart Institute and the Division of Cardiology at the University of Alberta in Edmonton.
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Ricky D. Turgeon
Assistant Professor at the University of British Columbia and Clinical Pharmacy Specialist at St Paul’s Hospital.
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Approximately half of patients with heart failure (HF) have an ejection fraction greater than 40% (ie, mildly reduced [41% to 49%] or preserved [≥50%]) ejection fraction).1,2 Unlike in patients with HF who have a reduced ejection fraction, no medication reduces the risk of dying in patients with HF and an ejection fraction greater than 40%.3 However, sodium-glucose cotransporter-2 inhibitors, also known as flozins, have demonstrated consistent reductions in hospitalizations due to HF and clinically important improvements in quality of life in these patients in 2 large randomized controlled trials (RCTs).4,5 These benefits come with trade-offs of cost, increased pill burden, and side effects (eg, genital mycotic infections, urinary tract infections, and symptomatic hypotension).6,7

This patient decision aid aims to engage patients in shared decision making about whether to start a flozin to treat HF and ejection fraction greater than 40%.

How was this decision aid developed?

We designed this tool based on patient decision aids from the Ottawa Patient Decision Aid template, which has been shown in RCTs to improve patient knowledge, concordance of decisions with their values, and engagement in decision making.8 We extracted data on patient-oriented outcomes from a meta-analysis of RCTs and a clinical trial to populate the information on benefits and harms, which are presented as stacked bar graphs with simple frequencies (out of 100) throughout 1 year.4,5

Decision aid

The tool, available from CFPlus*, is intended to help patients decide—independently or with clinicians—whether to use a flozin to treat HF with ejection fraction greater than 40%. The document outlines a stepwise process of shared decision making9: Figure 1 provides background information on diagnosis and treatment options and introduces the need for a decision. Figure 2 describes the benefits and harms associated with each option and helps elicit patient values and preferences. Figure 35,7,10-12 assesses patient knowledge, decision needs, readiness to make a decision, and preferred choice. Figure 4 highlights outcomes associated with flozin use and provides a space for notes.

Figure 1.
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Figure 1.

Decision overview

Figure 2.
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Figure 2.

Summary of benefits and harms (step 1) and preference elicitation activities (step 2)

Figure 3.
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Figure 3.

Assessment of readiness to make a decision (step 3) and patient decision (step 4)

Figure 4.
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Figure 4.

Glossary of terms and space for additional notes

Notes

We encourage readers to share some of their practice experience: the neat little tricks that solve difficult clinical situations. Praxis articles can be submitted online at http://mc.manuscriptcentral.com/cfp or through the CFP website (https://www.cfp.ca) under “Authors and Reviewers.”

Footnotes

  • ↵* The decision aid is available from https://www.cfp.ca. Go to the full text of the article online and click on the CFPlus tab.

  • Competing interests

    None declared

  • This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to https://www.cfp.ca and click on the Mainpro+ link.

  • Cet article se trouve aussi en français à la page 186.

  • Copyright © 2023 the College of Family Physicians of Canada

References

  1. 1.↵
    1. Bhambhani V,
    2. Kizer JR,
    3. Lima JAC,
    4. van der Harst P,
    5. Bahrami H,
    6. Nayor M, et al
    . Predictors and outcomes of heart failure with mid-range ejection fraction. Eur J Heart Fail 2018;20(4):651-9. Epub 2017 Dec 11.
    OpenUrl
  2. 2.↵
    1. Bozkurt B,
    2. Coats AJS,
    3. Tsutsui H,
    4. Magdy Abdelhamid C,
    5. Adamopolous S,
    6. Albert N, et al
    . Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail 2021;23(3):352-80. Epub 2021 Mar 3.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Martin N,
    2. Manoharan K,
    3. Davies C,
    4. Lumbers RT
    . Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction. Cochrane Database Syst Rev 2021;(5):CD012721.
  4. 4.↵
    1. Vaduganathan M,
    2. Docherty KF,
    3. Claggett BL,
    4. Jhund PS,
    5. de Boer RA,
    6. Hernandez AF, et al
    . SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials. Lancet 2022;400(10354):757-67. Epub 2022 Aug 27. Erratum in: Lancet 2023;401(10371):104.
    OpenUrlPubMed
  5. 5.↵
    1. Butler J,
    2. Filippatos G,
    3. Jamal Siddiqi T,
    4. Brueckmann M,
    5. Böhm M,
    6. Chopra VK, et al
    . Empagliflozin, health status, and quality of life in patients with heart failure and preserved ejection fraction: the EMPEROR-Preserved Trial. Circulation 2022;145(3):184-93. Epub 2021 Nov 15.
    OpenUrl
  6. 6.↵
    Pharmaceutic pricing. Edmonton, AB: Alberta College of Family Physicians; 2020. Available from: https://pricingdoc.acfp.ca/pricing/. Accessed 2022 Jan 27.
  7. 7.↵
    1. Anker SD,
    2. Butler J,
    3. Filippatos G,
    4. Ferreira JP,
    5. Bocchi E,
    6. Böhm M, et al
    . Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med 2021;385(16):1451-61. Epub 2021 Aug 27.
    OpenUrlCrossRefPubMed
  8. 8.↵
    1. Hoefel L,
    2. Lewis KB,
    3. O’Connor A,
    4. Stacey D
    . 20th anniversary update of the Ottawa Decision Support Framework: part 2 subanalysis of a systematic review of patient decision aids. Med Decis Making 2020;40(4):522-39. Epub 2020 Jun 10.
    OpenUrlCrossRefPubMed
  9. 9.↵
    1. Thériault G,
    2. Grad R,
    3. Dickinson JA,
    4. Breault P,
    5. Singh H,
    6. Bell NR, et al
    . To share or not to share. When is shared decision making the best option? Can Fam Physician 2020;66:327-31 (Eng), e149-54 (Fr).
    OpenUrlFREE Full Text
  10. 10.↵
    1. Légaré F,
    2. Kearing S,
    3. Clay K,
    4. Gagnon S,
    5. D’Amours D,
    6. Rousseau M, et al
    . Are you SURE? Assessing patient decisional conflict with a 4-item screening test. Can Fam Physician 2010;56:e308-14. Available from: https://www.cfp.ca/content/56/8/e308.long. Accessed 2023 Feb 13.
    OpenUrlAbstract/FREE Full Text
  11. 11.
    1. O’Connor A,
    2. Stacey D
    . Ottawa Personal Decision Guide. Ottawa, ON: Ottawa Hospital Research Institute; 2022. Available from: https://decisionaid.ohri.ca/decguide.html. Accessed 2023 Feb 13.
  12. 12.↵
    1. Solomon SD,
    2. McMurray JJV,
    3. Claggett B,
    4. de Boer RA,
    5. DeMets D,
    6. Hernandez AF, et al
    . Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med 2022;387(12):1089-98. Epub 2022 Aug 27.
    OpenUrlPubMed
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Canadian Family Physician: 69 (3)
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Patient decision aid for flozins in heart failure and ejection fraction greater than 40%
Blair J. MacDonald, Sheri L. Koshman, Ricky D. Turgeon
Canadian Family Physician Mar 2023, 69 (3) 181-185; DOI: 10.46747/cfp.6903181

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Patient decision aid for flozins in heart failure and ejection fraction greater than 40%
Blair J. MacDonald, Sheri L. Koshman, Ricky D. Turgeon
Canadian Family Physician Mar 2023, 69 (3) 181-185; DOI: 10.46747/cfp.6903181
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