An Electronically delivered, Patient-activation tool for Intensification of medications for Chronic Heart Failure with reduced ejection fraction: Rationale and design of the EPIC-HF trial

Venechuk, Grace; Khazanie, Prateeti; Page, Robert L.; Knoepke, Christopher E.; Helmkamp, Laura; Peterson, Pamela N.; Pierce, Kenneth; Thompson, Jocelyn S.; Huang, Janice; Strader, James R.; Dow, Tristan J.; Richards, Lance; Trinkley, Katy E.; Kao, David; McIlvennan, Colleen K.; Magid, David J.; Buttrick, Peter M.; Matlock, Daniel D.; Allen, Larry A.

doi:10.1016/j.ahj.2020.08.013

Cited by 5 publications

(1 citation statement)

References 32 publications

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“…Additionally, EHR-based patient as well as provider recommendation tools are potentially promising innovations in the optimization of heart failure care. Recently, an electronically delivered, patient-activation tool for intensification of chronic heart failure medical therapy proved successful, suggesting that EHR-based patient education/engagement tools may improve GDMT [21 ▪▪ ]. The EHR-embedded PRagmatic Trial Of Messaging to Providers about Treatment of Heart Failure (PROMPT-HF) is evaluating the impact of tailored alerting of recommended GDMT on improving therapy and outcomes serves as a model for a new frontier in cardiovascular investigation [7,22].…”

Section: Lessons Learned From Large Heart Failure Quality Initiativesmentioning

confidence: 99%

The use of multidisciplinary teams, electronic health records tools, and technology to optimize heart failure population health

Martyn

Montgomery

Estep

2022

Current Opinion in Cardiology

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Purpose of reviewGiven the limited population level, adoption of optimal therapy that has been shown in recent clinical trials and heart failure registries, efforts to rapidly and safely improve adoption of guideline-directed medical therapy for heart failure should be prioritized. Opportunities to leverage remote monitoring technology, the electronic health record (EHR), and multidisciplinary teams to improve heart failure care merit review. Recent findingsDedicated multidisciplinary teams employing algorithmic medication titration schema have shown better efficacy than clinician alerts or quality initiatives that focus on education and audit-feedback processes alone. Technology that enables invasive pressure monitoring and wearable devices that transmit physiologic data have the potential to predict decompensation and allow for early intervention by alerting clinicians to signs of congestion/clinical worsening but further real-world data is needed to prove efficacy and develop effective treatment protocols.

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Section: Lessons Learned From Large Heart Failure Quality Initiativesmentioning

confidence: 99%

The use of multidisciplinary teams, electronic health records tools, and technology to optimize heart failure population health

Martyn

Montgomery

Estep

2022

Current Opinion in Cardiology

View full text Add to dashboard Cite

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Electronic Health Record Embedded Strategies for Improving Care of Patients With Heart Failure

Fuery

Kadhim²,

Samsky

et al. 2023

Curr Heart Fail Rep

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An Electronically Delivered Patient-Activation Tool for Intensification of Medications for Chronic Heart Failure With Reduced Ejection Fraction

et al. 2021

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Background: Major gaps exist in the routine initiation and dose up-titration of guideline-directed medical therapies (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF). Without novel approaches to improve prescribing, the cumulative benefits of HFrEF treatment will be largely unrealized. Direct-to-consumer marketing and shared decision making reflect a culture where patients are increasingly involved in treatment choices, creating opportunities for prescribing interventions that engage patients. Methods: The Electronically delivered, Patient-activation tool for Intensification of medications for Chronic Heart Failure with reduced ejection fraction (EPIC-HF) trial randomized patients with HFrEF from a diverse health system to usual care versus patient-activation tools—a 3-minute video and 1-page checklist—delivered electronically 1 week prior, 3 days prior and 24 hours prior to a cardiology clinic visit. The tools encouraged patients to work collaboratively with their clinicians to "make one positive change" in HFrEF prescribing. The primary endpoint was the percent of patients with GDMT medication initiations and dose intensifications from immediately preceding the cardiology clinic visit to 30 days, compared to usual care during the same period. Results: EPIC-HF enrolled 306 patients, 290 of whom attended a clinic visit during the study period: 145 were sent the patient-activation tools and 145 were controls. Median age was 65 years, 29% female, 11% black, 7% Hispanic, median ejection fraction 32%. Pre-clinic data revealed significant GDMT opportunities, with no patients on target doses of beta-blocker, sacubitril/valsartan, and mineralocorticoid receptor antagonists. From immediately preceding the cardiology clinic visit to 30 days later, 49.0% in the intervention and 29.7% in control experienced an initiation or intensification of their GDMT (p=0.001). The majority of these changes were made at the clinician encounter itself and involved dose uptitrations. There were no deaths, and no significant differences in hospitalization or emergency department visits at 30 days between groups. Conclusions: A patient-activation tool delivered electronically prior to a cardiology clinic visit improved clinician intensification of GDMT. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT03334188

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An Electronically delivered, Patient-activation tool for Intensification of medications for Chronic Heart Failure with reduced ejection fraction: Rationale and design of the EPIC-HF trial

Cited by 5 publications

References 32 publications

The use of multidisciplinary teams, electronic health records tools, and technology to optimize heart failure population health

The use of multidisciplinary teams, electronic health records tools, and technology to optimize heart failure population health

Electronic Health Record Embedded Strategies for Improving Care of Patients With Heart Failure

An Electronically Delivered Patient-Activation Tool for Intensification of Medications for Chronic Heart Failure With Reduced Ejection Fraction

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