I’m Yuhui Zhang from China Fuwai Hospital, also named as the National Centre of Cardiovascular Diseases (NCCD), and I am Director of the Heart Failure Centre of Fuwai Hospital. I majored in heart failure (HF), cardiomyopathy, and cardio-oncology.
Why was the STRONG-HF protocol of optimising GDMT to the maximum tolerable dose for patients with Acute HF included in the most recent guideline update for China?
China’s latest guideline, the National Heart Failure Guideline 2023, includes STRONG-HF data because the [STRONG-HF] study is based on evidence-based medicine and can provide a more standardised and refined management strategy and new ideas for hospitalised HF patients after discharge. The significance of the STRONG-HF trial is reflected in the following points:
First, to improve the therapeutic response. An intensive therapy regimen can improve patients’ response to the treatment and enhance therapeutic efficacy.
[An] intensive therapy regimen can help to reduce the rehospitalisation rate of HF patients. Also it can improve the quality of life. The optimised therapy can better alleviate HF symptoms, thereby improving the patients’ quality of life.Standardised treatment procedures. Updating the guidelines will help us standardize the treatment procedures for clinicians and ensure that patients receive consistent and high-quality [care].
NT-proBNP-guided therapy. The [STRONG-HF] study also emphasized the rapid titration of GDMT according to the NT-proBNP and other clinical index for follow-up. It showed it is very precise and effective.
The STRONG[-HF] study also emphasised on patient education. The updated guideline places more emphasis on patient education to enhance patient self-management, including lifestyle modification, medication management, and so on.
What are some of the challenges or considerations in implementing the STRONG-HF protocol into clinical practice in China?
There are some challenges in the situation of HF in China. The first is the uneven distribution of healthcare resources. There are a lot of disparities in healthcare resources between different regions in China, especially in the rural and remote areas.
There may be insufficient healthcare professionals and facilities to implement the intensive treatment regimen. The monitoring, evaluation, and titration system is not enough. An effective monitoring system which includes NT-proBNP and other clinical indicators needs to be established to evaluate the safety and effectiveness of the treatment to make timely titration as needed.
Also, there is some shortage of multidisciplinary team collaboration. The cooperation between the cardiologists, nurses, and other doctors is very important, and it needs to be strengthened to ensure comprehensive management of patient care.
We also [need] to improve the patient adherence and self-management ability. The patients may lack the necessary education and self-management ability, which is required to adhere to the frequent medication adjustments and the monitoring demands of the intensive treatment. It is crucial to assess patient adherence through frequent follow-ups.
How might clinicians in China overcome these challenges?
In recent years, we just set up some measures to improve the quality of HF management.
The first [is] to develop the guidelines and consensus. In the recent, nearly 10 years, we published over 20 guidelines and consensus in China, focused on HF and related diseases. These guidelines and consensus helped to establish standardised diagnosis and treatment protocols for HF in China, thereby improving the clinical diagnostic and treatment ability of Chinese doctors in managing HF and related conditions.
The second measure is to build a specialised HF medical consortium under the leadership of NCCD, initiating and promoting the establishment and certification of the HF centres. By implementing the National Heart Failure Medical Quality Control and Improvement Project, we lead the Heart Failure Working Group of the National Cardiovascular Disease System Medical Quality Control Centre in establishing a comprehensive HF medical quality control system in China. This aims to standardise the HF diagnosis and treatment process and enhance the consistency of HF care across different regions.
And the third measure is on specialised training in HF and cardiomyopathy. It is very important to strengthen the training of HF-specialised doctors and create online and offline platforms for academic exchange in HF management.
The fourth measure is the specific strategies for out-of-hospital HF management. These are some methods for establishing and improving follow-up systems for HF patients, such as developing referral and collaborative networks, and enhancing patient self-management skills and medication adherence.
