Osude Nkiru, Spall Harriette Van, Bosworth Hayden, Krychtiuk Konstantin, Spertus John, Fatoba Samuel, Fleisher Lee, Fry Edward, Green Jennifer, Greene Stephen, Ho Michael, Jackman Jennifer, Leopold Jane, Magwire Melissa, McGuire Darren, Mensah George, Tuttle Katherine R, Willey Vincent, Pagidipati Neha, Granger Christopher
Duke Clinical Research Institute, Durham, NC.
Department of Medicine, McMaster University, Ontario, Canada.
Am Heart J. 2025 Aug;286:18-34. doi: 10.1016/j.ahj.2025.03.005. Epub 2025 Mar 17.
Cardiovascular disease remains the leading cause of mortality and healthcare expenditures in the United States. It is also a major contributor to premature mortality, years lived with disability, and rising healthcare costs around the world. Despite the availability of proven therapies and interventions that could vastly decrease the burden of cardiovascular disease and cardiometabolic conditions, their implementation is poor, with generally less than half of patients being treated with the most effective therapies. Implementation science offers promise in bridging this gap and mitigating disparities. However, even though small studies have shown that there are effective methods to improve the implementation of evidence-based therapies, these methods have not been scaled to make an impact at the level of health systems or nationally. A coordinated, multi-stakeholder approach is essential to identify barriers to implementation on a broad scale and, more critically, to develop and deploy practical solutions. The Duke Clinical Research Institute conducted an Implementation Summit entitled "Scalability, Spread, and Sustainability" to explore strategies for advancing the uptake of evidence-based interventions for cardiometabolic diseases in healthcare in the United States. This manuscript presents the participants' multi-stakeholder perspective on the steps necessary to improve the implementation of evidence-based therapies in cardiometabolic disease. Key recommendations include focused efforts on evidence generation around broad implementation strategies, dissemination of the evidence generated, uptake of evidence into usual care settings, and investment in training the current and next generations of leaders in implementation.
心血管疾病仍然是美国死亡和医疗保健支出的主要原因。它也是全球过早死亡、残疾生活年限增加以及医疗成本上升的主要因素。尽管有经过验证的疗法和干预措施可大幅减轻心血管疾病和心脏代谢疾病的负担，但这些措施的实施情况不佳，通常只有不到一半的患者接受最有效的治疗。实施科学有望弥合这一差距并减少差异。然而，尽管小型研究表明有有效的方法来改善循证疗法的实施，但这些方法尚未扩大规模以在卫生系统层面或全国范围内产生影响。采取协调一致的多利益相关方方法对于广泛识别实施障碍至关重要，更关键的是，要制定和部署切实可行的解决方案。杜克临床研究所举办了一次题为“可扩展性、推广和可持续性”的实施峰会，以探索在美国医疗保健中推进心脏代谢疾病循证干预措施应用的策略。本手稿展示了参与者对于改善心脏代谢疾病循证疗法实施所需步骤的多利益相关方观点。关键建议包括集中精力围绕广泛的实施策略开展证据生成工作、传播所生成的证据、将证据纳入常规护理环境，以及投资培训当前和下一代实施领域的领导者。
