Electronic Alerts to Improve Heart Failure Therapy in Outpatient Practice

Ghazi, Lama; Yamamoto, Yu; Riello, Ralph; Coronel-Moreno, Claudia; Martin, Melissa; O'Connor, Kyle; Simonov, Michael; Huang, Jie; Olufade, Temitope; McDermott, James J.; Dhar, Ravi; Inzucchi, Silvio E.; Velázquez, Eric J.; Wilson, F. Perry; Desai, Nihar R.; Ahmad, Tariq

doi:10.1016/j.jacc.2022.03.338

Cited by 109 publications

(92 citation statements)

References 17 publications

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“…Several DHIs have shown potential for CVD management [ 18 33 34 35 36 37 38 39 40 41 42 43 44 ], including text message programmes [ 34 38 39 40 41 42 43 ], mobile (mHealth) apps [ 18 33 35 36 44 ], telehealth consultations [ 45 46 47 ], wearable devices [ 48 49 50 ], and electronic decision support tools [ 37 51 52 ]. This section provides several non-exhaustive examples of DHIs to illustrate their potential impact.…”

Section: Potential Of Digital Health In Preventing and Managing Cardi...mentioning

confidence: 99%

World Heart Federation Roadmap for Digital Health in Cardiology

et al. 2022

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More than 500 million people worldwide live with cardiovascular disease (CVD). Health systems today face fundamental challenges in delivering optimal care due to ageing populations, healthcare workforce constraints, financing, availability and affordability of CVD medicine, and service delivery. Digital health technologies can help address these challenges. They may be a tool to reach Sustainable Development Goal 3.4 and reduce premature mortality from non-communicable diseases (NCDs) by a third by 2030. Yet, a range of fundamental barriers prevents implementation and access to such technologies. Health system governance, health provider, patient and technological factors can prevent or distort their implementation. World Heart Federation (WHF) roadmaps aim to identify essential roadblocks on the pathway to effective prevention, detection, and treatment of CVD. Further, they aim to provide actionable solutions and implementation frameworks for local adaptation. This WHF Roadmap for digital health in cardiology identifies barriers to implementing digital health technologies for CVD and provides recommendations for overcoming them.

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Section: Potential Of Digital Health In Preventing and Managing Cardi...mentioning

confidence: 99%

World Heart Federation Roadmap for Digital Health in Cardiology

et al. 2022

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“…In this figure, we highlight opportunities to improve implementation in multiple aspects of HF care, from prevention of HF to patients with symptomatic heart failure, and across the care continuum. 3,10,32,45,46 F I G U R E 2 Framework for improving implementation across the care continuum.…”

Section: Trial Participants Are Not Representative Of Clinical Practicementioning

confidence: 99%

“…14 A successful example of nudges in HF prescribing was demonstrated the PROMPT-HF randomized trial. 32 Clinicians treating patients with HFrEF in the Yale-New Haven Health System were randomized to an intervention that included a best practice alert embedded in the EHR that guided clinicians to initiate evidencebased therapies for HFrEF. The alert included information such as left ventricular ejection fraction, recent kidney function, current medications for HFrEF, and opportunities for prescribing new classes of HF therapies.…”

Section: Provide Feedback and Education To Hospital Quality Teams And...mentioning

confidence: 99%

“…Opportunities in various phases of care to improve implementation of evidence‐based therapies for heart failure (HF). In this figure, we highlight opportunities to improve implementation in multiple aspects of HF care, from prevention of HF to patients with symptomatic heart failure, and across the care continuum 3,10,32,45,46 …”

Section: Introductionmentioning

confidence: 99%

“…A successful example of nudges in HF prescribing was demonstrated the PROMPT‐HF randomized trial 32 . Clinicians treating patients with HFrEF in the Yale‐New Haven Health System were randomized to an intervention that included a best practice alert embedded in the EHR that guided clinicians to initiate evidence‐based therapies for HFrEF.…”

Section: Introductionmentioning

confidence: 99%

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Improving implementation of evidence‐based therapies for heart failure

DeVore

Bosworth

Granger

2022

Clinical Cardiology

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Treatment options for patients with heart failure have improved rapidly over the last few decades. Data from large scale clinical trials demonstrate that medical and device therapies can improve quality of life, reduce hospitalizations for acute heart failure, and reduce mortality. However, the use of many of these therapies in routine practice is remarkably low. There are many reasons for suboptimal implementation of evidence‐based therapies for heart failure, and we believe addressing the large gap between what can be accomplished in clinical trials versus routine practice is a critical and urgent public health issue. In this review, we outline reasons for this implementation gap and review recent studies attempting to address this issue. We also provide recommendations for future interventions and areas of clinical investigation to improve implementation for patients with heart failure.

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Coordinated Care to Optimize Cardiovascular Preventive Therapies in Type 2 Diabetes

Pagidipati

Nelson

Kaltenbach

et al. 2023

JAMA

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ImportanceEvidence-based therapies to reduce atherosclerotic cardiovascular disease risk in adults with type 2 diabetes are underused in clinical practice.ObjectiveTo assess the effect of a coordinated, multifaceted intervention of assessment, education, and feedback vs usual care on the proportion of adults with type 2 diabetes and atherosclerotic cardiovascular disease prescribed all 3 groups of recommended, evidence-based therapies (high-intensity statins, angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers [ARBs], and sodium-glucose cotransporter 2 [SGLT2] inhibitors and/or glucagon-like peptide 1 receptor agonists [GLP-1RAs]).Design, Setting, and ParticipantsCluster randomized clinical trial with 43 US cardiology clinics recruiting participants from July 2019 through May 2022 and follow-up through December 2022. The participants were adults with type 2 diabetes and atherosclerotic cardiovascular disease not already taking all 3 groups of evidence-based therapies.InterventionsAssessing local barriers, developing care pathways, coordinating care, educating clinicians, reporting data back to the clinics, and providing tools for participants (n = 459) vs usual care per practice guidelines (n = 590).Main Outcomes and MeasuresThe primary outcome was the proportion of participants prescribed all 3 groups of recommended therapies at 6 to 12 months after enrollment. The secondary outcomes included changes in atherosclerotic cardiovascular disease risk factors and a composite outcome of all-cause death or hospitalization for myocardial infarction, stroke, decompensated heart failure, or urgent revascularization (the trial was not powered to show these differences).ResultsOf 1049 participants enrolled (459 at 20 intervention clinics and 590 at 23 usual care clinics), the median age was 70 years and there were 338 women (32.2%), 173 Black participants (16.5%), and 90 Hispanic participants (8.6%). At the last follow-up visit (12 months for 97.3% of participants), those in the intervention group were more likely to be prescribed all 3 therapies (173/457 [37.9%]) vs the usual care group (85/588 [14.5%]), which is a difference of 23.4% (adjusted odds ratio [OR], 4.38 [95% CI, 2.49 to 7.71]; P &lt; .001) and were more likely to be prescribed each of the 3 therapies (change from baseline in high-intensity statins from 66.5% to 70.7% for intervention vs from 58.2% to 56.8% for usual care [adjusted OR, 1.73; 95% CI, 1.06-2.83]; ACEIs or ARBs: from 75.1% to 81.4% for intervention vs from 69.6% to 68.4% for usual care [adjusted OR, 1.82; 95% CI, 1.14-2.91]; SGLT2 inhibitors and/or GLP-1RAs: from 12.3% to 60.4% for intervention vs from 14.5% to 35.5% for usual care [adjusted OR, 3.11; 95% CI, 2.08-4.64]). The intervention was not associated with changes in atherosclerotic cardiovascular disease risk factors. The composite secondary outcome occurred in 23 of 457 participants (5%) in the intervention group vs 40 of 588 participants (6.8%) in the usual care group (adjusted hazard ratio, 0.79 [95% CI, 0.46 to 1.33]).Conclusions and RelevanceA coordinated, multifaceted intervention increased prescription of 3 groups of evidence-based therapies in adults with type 2 diabetes and atherosclerotic cardiovascular disease.Trial RegistrationClinicalTrials.gov Identifier: NCT03936660

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Electronic Alerts to Improve Heart Failure Therapy in Outpatient Practice

Cited by 109 publications

References 17 publications

World Heart Federation Roadmap for Digital Health in Cardiology

World Heart Federation Roadmap for Digital Health in Cardiology

Improving implementation of evidence‐based therapies for heart failure

Coordinated Care to Optimize Cardiovascular Preventive Therapies in Type 2 Diabetes

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