Heart Failure
Conditions
Brief summary
This study will test an automated, electronic health record (EHR-)embedded alert to improve prescribing of guideline-directed medical therapy for patients with heart failure and reduced ejection fraction (HFrEF). The investigators have previously tested and implemented this alert at NYU Langone Health (NYULH), and will now test and implement this alert across three other health systems.
Interventions
OTHEREHR-Emedded Alert
For patients randomized to the intervention group, an automated, EHR-embedded alert will be visible in the patient's chart that promotes appropriate medical therapy for patients with HFrEF.
Sponsors
NYU Langone Health
Massachusetts General Hospital
University of Pennsylvania
OhioHealth
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Patient with an encounter visit at participating cardiology practice during the study period * Patient with EF of less than or equal to 40% on most recent echocardiogram at the time of visit * Patient ages 18-90
Exclusion criteria
* Pregnancy * Ventricular assist device * Hospice * Cardiac amyloid * Medication-specific exclusion for MRA: most recent systolic blood pressure less than 105 mm Hg, most recent potassium \< 5.1, any potassium \> 5.5, most recent glomerular filtration rate \< 30 (using MDRD equation), or a documented MRA allergy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Patients with a Prescription for Mineralocorticoid Antagonists (MRA) | Up to Day 30 | Measured at the prescription encounter level using patient EHR data. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Patients with a Prescription for Beta-Blocker (BB) | Up to Day 30 | Measured at the prescription encounter level using patient EHR data. |
| Number of Patients with a Prescription for ACE-I/ARB/ARNI | Up to Month 36 | Prescription for angiotensin converting enzyme-inhibitors/angiotensin receptor blockers/angiotensin receptor neprilysin inhibitors (ACE-I/ARB/ARNI) measured at the prescription encounter level using patient EHR data. |
| Number of Patients with a Prescription for Sodium-Glucose Cotransporter-2 Inhibitor (SGLT2i) | Up to Month 36 | Measured at the prescription encounter level using patient EHR data. |
| Number of Patients with Hyperkalemia | Up to Month 36 | Measured using patient EHR data. |
| Number of Patients who are Hospitalized | Up to Month 36 | Measured using patient EHR data. |
| Number of Patients who are Hospitalized for Heart Failure (HF) | Up to Month 36 | Measured using patient EHR data. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORAmrita Mukhopadhyay
NYU Langone Health
Outcome results
None listed