EHR alerts spurred prescription of guideline-recommended heart failure treatments

April 04, 2022

2 minute read


Source/Disclosures

Source:

Ghazi L, et al. Joint American College of Cardiology/New England Journal of Medicine Last minute clinical trials. Presented at the American College of Cardiology Scientific Session; April 2-4, 2022; Washington, DC (hybrid meeting).

Disclosures:
PROMPT-HF was funded by AstraZeneca. Ahmad claims to be a consultant for Amgen, Cytokinetics and Sanofi Aventis and has received research funding from AstraZeneca, Boehringer Ingelheim, Cytokinetics and Relypsa.

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WASHINGTON — A personalized alert triggered through the electronic health record during office visits has resulted in more frequent prescription of guideline-compliant medical treatments for HF patients with reduced ejection fraction.

EHR alerts also increased the titration rate of currently prescribed HFrEF therapies, when the alert indicated it might be beneficial, according to results from the PROMPT-HF trial, which were presented at the scientific session of the American College of Cardiology.


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“Easily scalable strategy”

Tariq Ahmad

“We know that guideline-directed medical therapy improves clinical outcomes in heart failure with reduced ejection fraction, but it remains vastly under-prescribed,” said Tariq Ahmad, MD, MPH, associate professor of medicine, medical director of advanced heart failure and cardiovascular medicine, and head of the heart failure program at Yale School of Medicine. “Efforts to optimize guideline-directed medical therapy are abundant and resource-intensive, but limited evidence supports their use. Electronic health records can be used to target and individualize guideline-directed medical therapy recommendations. This approach is easily scalable and is a low-cost way to accelerate high-value care. »

The PROMT-HF trial included 100 providers and more than 1,300 patients with HFrEF (median age, 72 years; 31% female; median left ventricular ejection fraction, 32%) in the Yale Health System -New Haven, and used its built-in data from DSE (Epic Systems). The researchers did not recruit patients with HFrEF already on quadruple therapy.

Ahmad said the PROMPT-HF cohort was similar in terms of demographics, LVEF and medical therapies prescribed at baseline to that of the larger CHAMP-HF trial.

Providers were randomly assigned to receive an EHR alert or usual care without an alert. The personalized alerts were triggered for eligible patients the moment a clinician opened the order entry module in the patient’s EHR, which provided them with personalized medical therapy recommendations recommended by the guidelines.

Increase in prescriptions

The rate of prescribing an additional class of medical treatment within the guidelines at 30 days, the primary outcome of PROMPT, was higher among providers who received an EHR alert compared to no alert (RR = 1, 41, 95% CI, 1.03-1.93; P = .03). This finding translated into a necessary number of alerts of 14 to improve guideline-directed medical treatment for a patient with HFrEF.

The alert also resulted in increased rates of the composite secondary outcome of adding another class of guideline-directed medical therapy at 30 days and increasing current HFrEF therapy compared to no alert (RR = 1.39, 95% CI, 1.08-1.79; P = .01). This finding translated into a required number of alerts of 10 to improve guideline-directed medical treatment for a patient with HFrEF.

There were no interactions by patient age, gender, race, insurance status, LVEF, or baseline treatment on the effects of the alert on changes in medical treatment consistent with guidelines. .

Vendors were also asked about awareness of the guidelines and user experience.

“We asked physicians to complete a 20-question survey taken from the guidelines to see what their knowledge of the guidelines was before and after the study,” Ahmad said. “We also asked them questions to find out if they found the alert useful or not. It was the only alert in outpatients. On the hospitalization side, there were a lot of alerts. is important there, but 79% of clinicians said they found the alerts helpful.”

The study was published simultaneously in the Journal of the American College of Cardiology.

“A personalized alert triggered via the electronic health record during office visits resulted in a significantly higher number of heart failure patients with reduced ejection fractions on appropriate medical treatment as directed,” Ahmad said. . “We believe this inexpensive tool can be quickly integrated into EHR integrated healthcare systems and lead to widespread improvements in the care of patients with heart failure.”

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