Prescribing Heart Failure Drugs with EHR Alerts

In a study published in the Journal of the American College of Cardiology, researchers evaluated the impact of a tailored EHR alert on prescribing recommended heart failure medications. 

The treatment gap for heart failure patients

Heart failure is a chronic condition that affects millions of people worldwide. The recommended treatment for heart failure includes medications such as angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs), which have been shown to improve patient outcomes.

However, studies have shown that many patients with heart failure do not receive these medications, which can lead to poor health. The recent study aimed to address the significant treatment gap that affects many patients across the United States.

Slowing down the heart failure 

According to Amrita Mukhopadhyay, MD, clinical instructor in the department of medicine at NYU Langone Health says that Mineralocorticoid Receptor Antagonists (MRAs) which include spironolactone and eplerenone, are effective in slowing the progression of heart failure and are recommended for most patients with heart failure with reduced ejection fraction (HFrEF).

And more than two-thirds of eligible patients do not receive them. Closing this gap could save over 20,000 lives annually in the United States. This motivated the researchers to investigate the topic.

The study enrolled 2,211 patients and used cluster randomization by a cardiologist for a 6-month duration. The study assessed two tools to encourage doctors to prescribe MRAs for HFrEF patients. 

• The first tool was an EHR alert that provided vital data points necessary for prescribing MRA medications for the patient the clinician was currently seeing and 
• The second was a short monthly inbox message encouraging doctors to review the records of multiple MRA-eligible patients at once. 

Related: https://www.vozo.xyz/blog/the-role-of-remote-therapeutic-monitoring-in-making-patients-life-comfortable/#more-2608

Increase in MRA prescriptions

The researchers randomly divided 180 cardiologists within an extensive health system into three groups of 60; one group received EHR alerts, another group received monthly inbox messages, and the third group did not receive either intervention. 

New MRA prescriptions were written for 29.6% of patients in the conservative group, 15.6% in the message group, and 11.7% in the control group (RR for alert vs. control = 2.53; 95% CI, 1.77-3.62; P < .0001; RR for alert vs. message = 1.67; 95% CI, 1.21-2.29; P = .002).

By the end of the study, the researchers found that receiving the EHR alert increased the likelihood of prescribing MRA therapy by 2.5 times, while receiving the inbox message increased that likelihood by 1.5 times compared with receiving no intervention. 

Expanding the alert system

The study attributed the success of the EHR alerts to the fact that they were carefully targeted to the situations in which they would be most helpful. They were only sent to cardiologists, who were the most likely to prescribe MRAs.

The findings suggest that well-designed electronic tools can increase medication prescribing and have a low cost and high impact on patient outcomes. If the improvement observed in the study is replicated nationwide, it could save over 3,500 lives per year. 

The researchers plan to expand the alert system to more health systems and study the impact of the intervention over a longer duration.

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