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

Fuery, Michael; Kadhim, Bashar; Samsky, Marc D.; Freeman, James V.; Clark, Katherine; Desai, Nihar R.; Wilson, F. Perry; Ahmed, Tanjeeb; Ahmad, Tariq

doi:10.1007/s11897-023-00614-0

Cited by 2 publications

(2 citation statements)

References 29 publications

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“…A full set of search terms and strategies for each database can be found in eMethods in the Supplement. Sources from related reviews were also screened for possible inclusion …”

Section: Methodsmentioning

confidence: 99%

Interventions for Optimization of Guideline-Directed Medical Therapy

Tang,

Brownell,

Roberts

et al. 2024

JAMA Cardiol

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ImportanceImplementation of guideline-directed medical therapy (GDMT) in real-world practice remains suboptimal. It is unclear which interventions are most effective at addressing current barriers to GDMT in patients with heart failure with reduced ejection fraction (HFrEF).ObjectiveTo perform a systematic review to identify which types of system-level initiatives are most effective at improving GDMT use among patients with HFrEF.Evidence ReviewPubMed, Embase, Cochrane, CINAHL, and Web of Science databases were queried from January 2010 to November 2023 for randomized clinical trials that implemented a quality improvement intervention with GDMT use as a primary or secondary outcome. References from related review articles were also included for screening. Quality of studies and bias assessment were graded based on the Cochrane Risk of Bias tool and Oxford Centre for Evidence-Based Medicine.FindingsTwenty-eight randomized clinical trials were included with an aggregate sample size of 19 840 patients. Studies were broadly categorized as interdisciplinary interventions (n = 15), clinician education (n = 5), electronic health record initiatives (n = 6), or patient education (n = 2). Overall, interdisciplinary titration clinics were associated with significant increases in the proportion of patients on target doses of GDMT with a 10% to 60% and 2% to 53% greater proportion of patients on target doses of β-blockers and renin-angiotensin-aldosterone system inhibitors, respectively, in intervention groups compared with usual care. Other interventions, such as audits, clinician and patient education, or electronic health record alerts, were also associated with some improvements in GDMT utilization, though these findings were inconsistent across studies.Conclusions and RelevanceThis review summarizes interventions aimed at optimization of GDMT in clinical practice. Initiatives that used interdisciplinary teams, largely comprised of nurses and pharmacists, most consistently led to improvements in GDMT. Additional large, randomized studies are necessary to better understand other types of interventions, as well as their long-term efficacy and sustainability.

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“…A full set of search terms and strategies for each database can be found in eMethods in the Supplement. Sources from related reviews were also screened for possible inclusion …”

Section: Methodsmentioning

confidence: 99%

Interventions for Optimization of Guideline-Directed Medical Therapy

Tang,

Brownell,

Roberts

et al. 2024

JAMA Cardiol

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“…An explanation given for the effectiveness of this method is that the tools engaged and activated patients before the clinical encounter. The PROMPT-HF cluster RCT by Ghazi et al focused on outpatient CDSS alerts to improve GDMT [ 50 , 51 ]. The study enrolled 1310 outpatient patients with HFrEF.…”

Section: Clinical Decision Support Systemsmentioning

confidence: 99%

Digital Solutions to Optimize Guideline-Directed Medical Therapy Prescriptions in Heart Failure Patients: Current Applications and Future Directions

Man,

Klopotowska,

Asselbergs

et al. 2024

Curr Heart Fail Rep

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Purposeof Review Guideline-directed medical therapy (GDMT) underuse is common in heart failure (HF) patients. Digital solutions have the potential to support medical professionals to optimize GDMT prescriptions in a growing HF population. We aimed to review current literature on the effectiveness of digital solutions on optimization of GDMT prescriptions in patients with HF. Recent Findings We report on the efficacy, characteristics of the study, and population of published digital solutions for GDMT optimization. The following digital solutions are discussed: teleconsultation, telemonitoring, cardiac implantable electronic devices, clinical decision support embedded within electronic health records, and multifaceted interventions. Effect of digital solutions is reported in dedicated studies, retrospective studies, or larger studies with another focus that also commented on GDMT use. Overall, we see more studies on digital solutions that report a significant increase in GDMT use. However, there is a large heterogeneity in study design, outcomes used, and populations studied, which hampers comparison of the different digital solutions. Barriers, facilitators, study designs, and future directions are discussed. Summary There remains a need for well-designed evaluation studies to determine safety and effectiveness of digital solutions for GDMT optimization in patients with HF. Based on this review, measuring and controlling vital signs in telemedicine studies should be encouraged, professionals should be actively alerted about suboptimal GDMT, the researchers should consider employing multifaceted digital solutions to optimize effectiveness, and use study designs that fit the unique sociotechnical aspects of digital solutions. Future directions are expected to include artificial intelligence solutions to handle larger datasets and relieve medical professional’s workload.

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

Cited by 2 publications

References 29 publications

Interventions for Optimization of Guideline-Directed Medical Therapy

Interventions for Optimization of Guideline-Directed Medical Therapy

Digital Solutions to Optimize Guideline-Directed Medical Therapy Prescriptions in Heart Failure Patients: Current Applications and Future Directions

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