Guideline-directed medical therapies and guideline-directed nonpharmacological therapies improve quality of life and survival in patients with heart failure (HF), but eligible patients, particularly women and individuals from underrepresented racial and ethnic groups, are often not treated with these therapies. Implementation science uses evidence-based theories and frameworks to identify strategies that facilitate uptake of evidence to improve health. In this scientific statement, we provide an overview of implementation trials in HF, assess their use of conceptual frameworks and health equity principles, and provide pragmatic guidance for equity in HF. Overall, behavioral nudges, multidisciplinary care, and digital health strategies increased uptake of therapies in HF effectively but did not include equity goals. Few HF studies focused on achieving equity in HF by engaging stakeholders, quantifying barriers and facilitators to HF therapies, developing strategies for equity informed by theory or frameworks, evaluating implementation measures for equity, and titrating strategies for equity. Among these HF equity studies, feasibility was established in using various educational strategies to promote organizational change and equitable care. A couple include ongoing randomized controlled pragmatic trials for HF equity. There is great need for additional HF implementation trials designed to promote delivery of equitable guideline-directed therapy.

中文翻译：

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实施科学以实现心力衰竭护理的公平：美国心脏协会的科学声明

指南指导的药物治疗和指南指导的非药物治疗可改善心力衰竭（HF）患者的生活质量和生存率，但符合条件的患者，特别是来自代表性不足的种族和族裔群体的女性和个人，通常不会接受这些治疗。实施科学使用基于证据的理论和框架来确定促进采用证据来改善健康的策略。在这份科学声明中，我们概述了心力衰竭的实施试验，评估了它们对概念框架和健康公平原则的使用，并为心力衰竭的公平性提供了务实的指导。总体而言，行为推动、多学科护理和数字健康策略有效地增加了心力衰竭治疗的采用，但不包括公平目标。很少有心力衰竭研究侧重于通过让利益相关者参与、量化心力衰竭治疗的障碍和促进因素、制定基于理论或框架的公平策略、评估公平的实施措施以及滴定公平策略来实现心力衰竭的公平性。在这些 HF 公平研究中，建立了使用各种教育策略促进组织变革和公平护理的可行性。一些研究包括正在进行的高频公平性随机对照实用试验。非常需要额外的心力衰竭实施试验，旨在促进公平的指南指导治疗的实施。