Researchers from the Yale School of Medicine have found that electronic health record (EHR) alerts can help improve the quality of care for outpatients with heart failure with reduced ejection fraction (HFrEF). The group shared its findings in the Journal of the American College of Cardiology.[1]
“Efforts aimed at optimizing guideline-directed medical therapy (GDMT) in patients with HFrEF are abundant across hospitals and healthcare systems, but there is limited evidence to support whether such resource-intensive interventions have any demonstrable benefit,” wrote first author Lama Ghazi, MD, PhD, a fellow with Yale’s Clinical and Transnational Research Accelerator, and colleagues.
Ghazi et al. examined the impact of an EHR-based alert system designed, with help from physicians, to inform healthcare providers about key data such as the patient’s current left ventricular ejection fraction (LVEF), blood pressure and heart rate.
The alert also provides a detailed rundown of which recommended medications the patient is and is not currently taking and FDA-supported details about each medication. The provider receiving the alert is then asked to respond to the alert by saying, “I will adjust medications,” “medication changes not clinically indicated” or “defer for other reason.” A free text field is also provided if the individual responding to the alert wants to add any additional comments.
“Finally, there was the option to skip previous questions and either ‘agree’ with or ‘dismiss’ the alert,” the authors added.
A total of 100 providers affiliated with a single U.S. health system were randomized to either follow this intervention or carry on as normal. The study included a total of 1,310 HFrEF patients with a median age of 72 years old. Sixty-nine percent of patients were men.
Overall, at the start of the study, 84% of patients were receiving beta-blockers, 71% were receiving RAAS inhibitors, 29% were receiving mineralocorticoid receptor antagonists (MRAs) and 11% were receiving SGLT2 inhibitors. The study’s primary outcome, an increase in the number of GDMT classes prescribed to a patient after 30 days, was seen in 26% of patients in the intervention group and 19% of patients in the standard care group.
These findings, the authors explained, are different from those from other studies that also focused on improving care through the EHR.
“These results contrast with those of earlier trials that failed to show an impact of informational EHR-based alerts on provider behavior,” the group wrote. “The likely reason for this difference is that the current study provided specific guidance on the basis of information rather than information alone, a distinction that has been noted in publications on behavioral economics. Furthermore, the alert was developed in concert with practicing clinicians, whose input was used in its design and timing during clinical workflow."
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.