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

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.
Figure 1.

Decision overview

Figure 2.
Figure 2.

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

Figure 3.
Figure 3.

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

Figure 4.
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.

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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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