For a study, researchers sought to examine if targeted, and personalized electronic health record (EHR) alerts advising guideline-directed medical therapy (GDMT) enhanced GDMT use in eligible individuals with HFrEF.
PROMPT-HF (PRagmatic study Of Messaging to Providers About Treatment of Heart Failure) was a cluster-randomized comparative efficacy trial that used EHRs. A total of 100 clinicians caring for HFrEF patients were randomly assigned to either alert or normal care. The alert informed clinicians of personalized GDMT recommendations as well as patient characteristics. At 30 days post-randomization, the primary outcome was an increase in the number of GDMT classes prescribed. Providers were polled on their awareness of guidelines and their user experience.
From April to October 2021, 1,310 ambulatory participants with HFrEF were included in the research. The median age was 72 years, 31% were female, 18% were Black, and the median left ventricular ejection fraction was 32%. At the start of the study, 84% of patients were taking β-blockers, 71% were taking a renin-angiotensin-aldosterone system inhibitor, 29% were using a mineralocorticoid receptor antagonist, and 11% were taking a sodium-glucose cotransporter-2 inhibitor. The primary outcome occurred in 176 of 685 (26%) alert arm participants versus 117 of 625 (19%) usual care arm participants, increasing GDMT class prescription by more than 40% after alert exposure (adjusted relative risk: 1.41; 95% CI: 1.03-1.93; P=0.03). The number of patients who needed to be alerted in order for the addition of GDMT classes to be increased was 14. A total of 79% of alerted clinicians believed that the notice was beneficial in facilitating better prescribing of HF medical treatment.
When compared to conventional treatment, a real-time, targeted, and personalized EHR-based warning system for outpatients with HFrEF resulted in considerably higher rates of GDMT at 30 days. The low-cost solution can be quickly implemented into clinical treatment, accelerating the uptake of high-value heart failure medications.