Overcoming Clinical Inertia in the Context of Non-Adherence With Guideline-Directed Medical Therapy for Heart Failure

Abstract Heart failure (HF) remains a leading cause of morbidity and mortality worldwide, despite advancements in guideline-directed medical therapies (GDMTs). A major obstacle to optimal HF management is clinical inertia, defined as the failure of health care providers to initiate or intensify therapy when indicated. This review examined the current state, contributing factors, and strategies for overcoming clinical inertia in HF. Studies have revealed substantial treatment gaps, with sub-optimal prescription rates and dosing of GDMT classes, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor-neprilysin inhibitors, β-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors. These treatment gaps persist over time and are associated with increased patient mortality and hospitalizations as well as reduced quality of life. Multiple factors contribute to clinical inertia, including patient-related factors (medication adherence and treatment understanding), provider-related factors (guideline familiarity, concerns regarding side effects, complex treatment decision-making), and health care system-related factors (fragmented care models and quality assessment frameworks). Strategies for overcoming clinical inertia involve patient empowerment through education and shared decision-making, provider education and clinical decision support tools, and redesigning HF care delivery. Specialized HF management systems, multidisciplinary collaboration, remote monitoring, and digital tools can promote guideline adherence. Continuous quality improvement by integrating research and practice is also essential. Addressing clinical inertia requires a multifaceted approach targeting patients, providers, and health care systems. By implementing targeted strategies, health care systems can bridge the evidence-practice gap, optimize GDMT utilization, and ultimately improve outcomes for this vulnerable patient population.