Electronic health record alert improves guideline-directed therapy prescription for HFrEF

News - Apr. 12, 2022

A Cluster-Randomized PRagmatic Trial Aimed At ImprOving Use Of Guideline Directed Medical Therapy In OutPatienTs With Heart Failure: PROMPT-HF

Presented at ACC.22 by Tariq Ahmad, MD (New Haven, CT, USA)

Introduction and methods

Background

Guideline-directed medical therapy (GDMT) for HFrEF comprises 4 medication classes proven to reduce hospitalizations and mortality: BB, ACEi/ARB/ARNI, MRA and SGLT2i. However, the adoption of these treatments in clinical practice remains suboptimal.

Aim of the study

The PRagmatic Trial Of Messaging to Providers about outpatient Treatment of Heart Failure (PROMPT-HF) was designed to test the hypothesis that targeted and tailored electronic health record (EHR) alerts recommending GDMT in patients with HFrEF would lead to higher rates of GDMT prescription compared with usual care.

Methods

The top 100 providers caring for the most HFrEF patients in the Yale-New Haven Health System were included in this study. Providers were randomized to receiving EHR-embedded best practice alerts when the provider is entering orders or no alert (usual care). The alert displayed patient characteristics and GDMT recommendations tailored to the patient. A total of 1310 ambulatory HFrEF patients were included in the study.

Outcomes

The primary outcome was increase in number of GDMT classes prescribed at 30 days after randomization. A secondary outcome was an increase in dose of currently prescribed GDMT or addition of a class of GDMT.

Main results

A larger proportion of patients in the alert arm received additional GDMT classes compared with the usual care arm (25.7% vs. 18.7%, RR: 1.38, 95% CI 1.03-1.93, P=0.03, Number Need to Alert = 14).
The composite outcome of an increase in dose or addition of a class of GDMT was observed in 36.2% of patients in the alert arm and in 26.2% of patients in the usual care arm (RR: 1.39, 95% CI 1.08-1.79, P=0.01, Number Need to Alert =10).

Conclusion

This randomized trial showed that a EHR-based alert led to higher rates of GDMT in HFrEF patients compared with usual care. Tariq Ahmad concluded: “This low-cost tool can be rapidly embedded into the EHR at integrated health care systems and lead to widespread improvements in the care of heart failure patients”.

-Our coverage of ACC.22 is based on the information provided during the congress-

This study was simultaneously published in J Am Coll Cardiol.