Broaching the Issue of Patient Education in Heart Failure Care, With Martha Gulati, MD

The evolution of the heart failure sphere has been a double-edged sword in recent years. Often, every major advancement in treatment represents another drug or therapy that patients are obligated to take, adding to an already significant treatment burden. Additionally, patients are rarely fully aware of the reason for their prescriptions, resulting in unnecessary confusion and, in some instances, reduced adherence.

Research has encouraged patient education in heart failure treatment, with studies indicating a substantial improvement in both patient adherence and patient outcomes. Even brief interventions, such as a 1-hour nurse-delivered educational session at the time of hospital discharge from a 2014 trial, resulted in substantial improvements.1

Martha Gulati, MD, associate director of the Barbra Streisand Women's Heart Center and director of cardiovascular disease prevention at the Smidt Heart Institute at Cedars Sinai Medical Center, gave a presentation during the American Heart Association’s Scientific Sessions 2025 in New Orleans, Louisiana, addressing these issues.2

For additional insight into how clinicians can improve patient education, the editorial team at HCPLive spoke with Gulati in the following Q&A:

HCPLive: How can the heart failure industry as a whole approach reducing the treatment burden faced by most patients?

Gulati: Well, I think it’s a challenge. When people get a diagnosis of heart failure and we talk about these four pillars of treatment, as well as treating all the other risk factors associated with heart failure, the medication burden becomes quite a large amount for any individual. And that leads to misunderstandings from the patients about why they’re taking so many drugs. And sometimes that confusion arises then, but it can also be when they feel better. They start to ask why they need to keep taking all these drugs. The amount of medication can also cause great expense and pill burden; over time, it just wears the patient down.

I think one of the things we could do better is explaining the disease process, how these medications individually work, and why we’re giving them so many medications. How’s it going to benefit them in the long term and in the short term? Because when people understand fully how the medications work, they’ll be more informed and more understanding that some of these drugs are going to be lifelong medications for them. If we partner with the patients and understand the reasons why they don’t want to take so many medications, whether it’s due to side effects, expense, or misunderstandings about how the medications work, we can better address these issues. I think that’s the most important part. Rather than us dictating “take these medications,” it’s important for the patient to understand what they’re doing, how the drugs are going to protect them in the long term, and what might be expected as a side effect of the medication, so they can be prepared and not surprised.

HCPLive: Do you believe patient education is a factor in this conversation, particularly given the rapid expansion of heart failure treatment over the last few years?

Gulati: I think patient education is the most important part of taking care of patients who are living with heart failure. This is a challenge, right? In our current day, when you see a patient, you not only have to examine them and prescribe for them, but there needs to be time to explain things to them. I think that patient education and doing shared decision making, understanding the role of therapies, is crucial. But so is understanding the role of lifestyle changes that they may need to make to improve their heart health. For instance, if they get referred to cardiac rehabilitation, how will that help them? Why are they being sent? Because I think sometimes people have different thoughts about cardiac rehab. Maybe they believe it’s only for people who’ve had heart surgery or heart stents. And yet, one of the main indications for cardiac rehab is also heart failure. Cardiac rehab is a major time commitment; it’s for 36 total visits generally, 3 days a week, for 12 weeks. That’s a lot to ask someone to do. But to understand how it might benefit them is really the missing piece. You can’t prescribe something, whether it’s cardiac rehab or medications or lifestyle changes, without explaining how that will impact them and keep them out of the hospital. In all the things we do for our patients, our goal is to keep them out of the hospital, reduce their disease burden, and hopefully prevent cardiac death. And understanding the burden of things from a patient’s perspective is so important, but we don’t spend enough time on patient education. We have a lot of tools out there.

HCPLive: What advice would you give to patients regarding addressing these concerns and asserting themselves in their care?

Gulati: I think one place I often refer people to is our Cardiosmart hub at the American College of Cardiology, because we have tools to encourage patients to come back and ask their doctor questions. Sometimes the first visit can be, “here’s a whole bunch of medications and a whole bunch of things you have to do.” But when they get home, they realize they don’t understand. And then they write out those questions and come to the next visit prepared to ask those questions. A physician on our side should be ready for those questions. And again, I do think the team aspect is important because I think that sometimes a physician may not have all the time in the world to sit with our patients, but we can partner with other team members, the physician assistants or nurse practitioners, who can spend some time addressing our patients’ questions.

HCPLive: On an individual level, how can clinicians work to incorporate the concerns and opinions of their patients?

Gulati: Well, that’s really the heart of shared decision making. It means putting the patient in the center and everyone else being outside that’s involved in that care, not outside the circle, just outside of the patient. And that we work to understand what impacts the patient, what is affecting their life, what their values are, what is hindering their ability to take certain medications or to do certain therapies that we advise. Any solutions that we can come up with can help the patient maybe improve their overall health. Ultimately, if we are not putting the patient at the center of their care, we will never be successful.

HCPLive: How can patients avoid being pushed out of their own care processes? How can they keep from being bystanders?

Gulati: For the patient, that means understanding the decisions that are being made about them should involve them. You know that expression, “nothing about me without me?” It’s the key to how we care for patients, regardless of the disease. We should be talking with them about what they can do, what barriers are keeping them from doing these things, and how we can overcome these barriers. Do we have solutions? Do we need to do certain things stepwise? Because there is often hesitation on the patient’s end to take a lot of medications. How do we work with them to really make them understand? And I think that should be central to all care, particularly heart failure, but I would say it’s true for all disease states.

Editor's Note: Gulati reports disclosures with Novartis, Esperion, Boehringer Ingelheim, and Merck.

References

1. Prasun MA. Heart failure patient education. Heart Lung. 2014;43(6):485. doi:10.1016/j.hrtlng.2014.08.002

2. Gulati M, Sharma K. Reframing Heart Failure Care: Amplifying Patient Voices in the Evolving Treatment Landscape. Presented at the American Heart Association’s Scientific Sessions 2025. New Orleans, Louisiana. November 8-10, 2025.