Heart Failure With Reduced Ejection Fraction
Conditions
Keywords
electronic health records, electronic nudge, guideline directed medical therapy
Brief summary
This is a prospective cohort study, where the investigators aim to investigate the effect of implementation of an electronic nudge alerting clinicians to the prescription of the 4 key pharmacological classes for the treatment of patients with heart failure and reduced ejection fraction (HFrEF) at the outpatient clinic in the Netherlands.
Interventions
OTHERBest practice alert for the notification of patients with HFrEF and recommended evidence-based therapies
An algorithm will check if the patients if the patient has an age \>18 year and is treated at the cardiology department for HFrEF. The use of GDMT is determined using prescriptions data electronic health records (EHR). If the patient does not receive treatment for all 4 drug classes (ACE/ARB/ARNi, beta-blocker, MRA, SGLT2-inhibitor), an electronic alert will be displayed suggesting the clinician to prescribe additional medication when clinically indicated, including relevant recent laboratory results (renal function and electrolytes) and other relevant measures (LVEF, blood pressure and heart rate). The alert is linked to an order set to aid in the prescription of GDMT according to current guidelines. Results will compared to a retrospective cohort (t=-12 to t=-6) months, and a silent mode cohort (t=-6 to t=0 months, in which a paired and a before and after analysis will be performed to evaluate the effect of the alert.
Sponsors
AstraZeneca
Yale University
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \> 18 years * Treatment for HFrEF at the outpatient clinic cardiology. * Documented reduced ejection fraction of \<40% based on cardiac ultrasound or cardiac magnetic resonance imaging.
Exclusion criteria
* Opt-out for the use of routine clinical data for research purposes
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Use of guideline-directed medical therapy (GDMT) | 30 days (primary), 6 months (secondary) | Using all therapies according to ESC guidelines |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| All-cause mortality | 1 year | All-cause mortality |
| Hospitalisation for Heart Failure | 6 months, 1 year | Hospitalisation for Heart Failure |
| other major cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, non-fatal stroke) | 6 months, 1 year | other major cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, non-fatal stroke) |
| renal events (>30% serum creatinine increase, hospitalization for acute kidney injury, development of end-stage kidney disease) | 30 days, 6 months, 1 year | renal events (\>30% serum creatinine increase, hospitalization for acute kidney injury, development of end-stage kidney disease) |
Countries
Netherlands
Contacts
Primary ContactFolkert Assselbergs, MD PhD
Backup ContactA Uijl
Outcome results
None listed