Building Electronic Tools To Enhance and Reinforce Cardiovascular Recommendations - Heart Failure

NCT05077293 | Completed

• 1 other identifier: QI-BETTER CARE-HF PS
• Study Type: observational
• Target: 596
• Locations: 1 country
• Sites: 1

Brief Summary

This is a feasibility study using a cross-over design to implement and compare a best practice alert (BPA) with an automated in-basket message to inform providers when a patient with heart failure and reduced ejection fraction (HFrEF) is not on appropriate medical therapy. The data from this pilot study will lead to a randomized controlled trial to compare the effectiveness of the BPA versus an automated in-basket message, versus usual care (no intervention).

Conditions

Heart Failure; Heart Failure With Reduced Ejection Fraction

Keywords

Best Practice Alert; In-Basket message; Mineralocorticoid Receptor Antagonists; MRA; guideline-directed medical therapy; GDMT

Outcome Measures

Primary Outcomes (2)

• Percentage of patients prescribed MRA

  14 days after alert

• Incidence of provider engagement with each alert type

  Provider engagement is reported when the provider clicks on links or buttons within each alert.

  14 days after alert

Study Arms (3)

Best Practice Alert group

Providers will receive a BPA at the time of visit for patients with HFrEF who are not on MRA (and who do not have contraindication to MRA). This alert will be visible on the first screen displayed in the electronic health record and will display the patient's current HFrEF therapies, EF, blood pressure, potassium, and glomerular filtration rate. The alert will give access to an outpatient heart failure order set, and also provide links to the most recent guidelines.

Other: Best Practice Alert (BPA)

In-Basket Message group

Providers will receive a biweekly in-basket messages linking to a list of patients who have been seen in the past year with HFrEF who are not on MRA (and who do not have contraindication to MRA). This list will display each patient's current hFrEF therapies, EF, blood pressure, potassium, glomerular filtration rate, and date of last visit. From the list, providers can access the patient's chart, order medications, and document communication with the patient.

Other: In-Basket Message

Control group

Patients who will receive the current standard practice of care (no alerts)

Interventions

Best Practice Alert (BPA) OTHER

A BPA will fire in the EHR reminding care providers of the best practice when prescribing medical therapies for heart failure patients.

Best Practice Alert group

In-Basket Message OTHER

An In-Basket message will be sent biweekly to care providers with a reminder of the best practice when prescribing medical therapies for heart failure

In-Basket Message group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Langone cardiology outpatients

You may qualify if:

• Cardiologist visit
• Transthoracic echocardiogram with the most recent EF \>= 40%

You may not qualify if:

• Hypotension: SBP \< 95
• Hyperkalemia: most recent K \> 5.1, or any K \>5.5
• Renal dysfunction: eGFR \< 30
• Ventricular assist device
• Hospice care

Sponsors & Collaborators

• NYU Langone Health: lead

Study Sites (1)

NYU Langone Health

New York, New York, 10016, United States

Location

MeSH Terms

Conditions

Heart Failure

Condition Hierarchy (Ancestors)

Heart Diseases; Cardiovascular Diseases

Study Design

• Study Type: observational
• Observational Model: CASE CROSSOVER
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: October 3, 2021
• First Posted: October 14, 2021
• Study Start: September 9, 2021
• Primary Completion: January 1, 2022
• Study Completion: January 1, 2022
• Last Updated: October 28, 2022

Record last verified: 2022-02

Locations

US (1)