New Solutions to Support Evidence-Based Prescribing for Heart Failure
Keywords
Chronic disease prevention, management, multiple chronic conditions
Types of Research
Dissemination and implementation research, practice based research
Summary
This study compares a traditional and personalized clinician decision support (CDS) tool in a pragmatic randomized controlled trial. The CDS addresses misconceptions related to the suboptimal prescribing of medications for heart failure with reduced ejection fraction (HFrEF). Dissemination and implementation science frameworks (PRISM/RE-AIM) guide the design and evaluation of the CDS.
Significance
This study strategically addresses misconceptions to GDMT by personalizing CDS to meet clinicians’ individualized informational needs; thereby, has the potential to improve prescribing of GDMT and outcomes for high-risk patients with HFrEF.
Impact
This study has the potential to substantially improve prescribing of GDMT and outcomes for high-risk patients with HFrEF. The results of this study will also provide methodological expertise to others who wish to use this approach to improve evidence-based prescribing for other disease states and across patient care settings.
Health Equity Implications
Most patients (>90%) with HFrEF do not receive GDMT (2–4). These medications reduce re-hospitalization, cardiovascular events and healthcare costs and have repeatedly demonstrated marked improvements in survival and quality of life. We aim to improve GDMT for HFrEF, specifically beta blockers, SGLT2is, MRAs, and sacubitril/valsartan.
Lessons Learned
TBD
Products
Publications
1. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Vol. 145, Circulation. 2022.
2. Ouwerkerk W, Voors AA, Anker SD, Cleland JG, Dickstein K, Filippatos G, et al. Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure: A prospective European study. Eur Heart J. 2017;38(24):1883–90.
3. Greene SJ, Butler J, Albert NM, DeVore AD, Sharma PP, Duffy CI, et al. Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry. J Am Coll Cardiol. 2018.
4. Allen LA, Venechuk G, McIlvennan CK, Page, II RL, Knoepke CE, Helmkamp LJ, et al. An Electronically Delivered, Patient-Activation Tool for Intensification of Medications for Chronic Heart Failure with Reduced Ejection Fraction: The EPIC-HF Trial. Circulation. 2020 Nov 17.