The following is a summary of “Cluster-Randomized Trial Comparing Ambulatory Decision Support Tools to Improve Heart Failure Care,” published in the April 2023 issue of Cardiology by Mukhopadhyay, et al.

Patients with heart failure with reduced ejection fraction (HFrEF) often do not receive an adequate prescription for mineralocorticoid receptor antagonists (MRAs). For a study, researchers sought to compare the effectiveness of two automated, electronic health record (EHR)-embedded tools with usual care in promoting MRA prescribing for eligible patients with HFrEF.

The BETTER CARE-HF (Building Electronic Tools to Enhance and Reinforce Cardiovascular Recommendations for Heart Failure) trial was a pragmatic, cluster-randomized trial with three arms. The trial compared the effectiveness of an alert during individual patient encounters, a message about multiple patients between encounters, and usual care in promoting MRA prescribing. The study included adult patients with HFrEF, no current MRA prescription, no contraindications to MRAs, and an outpatient cardiologist within a large health system. Patients were cluster-randomized based on their cardiologist (60 patients per arm).

A total of 2,211 patients were included in the study (alert: 755, message: 812, usual care [control]: 644). The average age of the patients was 72.2 years, with an average ejection fraction of 33%. Most patients were male (71.4%) and White (68.9%). New MRA prescriptions were observed in 29.6% of patients in the alert arm, 15.6% in the message arm, and 11.7% in the control arm. The alert significantly increased MRA prescribing compared to usual care (relative risk: 2.53; 95% confidence interval: 1.77-3.62; P < 0.0001) and also improved MRA prescribing compared to the message (relative risk: 1.67; 95% CI: 1.21-2.29; P = 0.002). The number of patients needed to receive an alert to result in an additional MRA prescription was 5.6.

An automated, patient-specific, EHR-embedded alert significantly increased MRA prescribing compared to a message and usual care. The findings highlighted the potential of EHR-embedded tools to substantially improve the prescription of life-saving therapies for patients with HFrEF.

Source: jacc.org/doi/10.1016/j.jacc.2023.02.005