Best Practice Advisory Alerts for Heart Failure

(PROMPTHF-Inova Trial)

Overseen By Bhruga Shah, MS, BSN-RN

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Inova Health Care Services

Disqualifiers: Hospice, Prior heart transplant, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

5000 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if electronic alerts can assist doctors in prescribing the correct heart failure medications to patients not already receiving them. It compares two groups: one where doctors receive alerts about missing medications when entering orders, and another where doctors continue their usual care without alerts. The goal is to enhance medication management for heart failure patients with a reduced ejection fraction, which measures how well the heart pumps blood. Ideal participants are those diagnosed with heart failure, have a left ventricular ejection fraction of 40% or less, and are seen by a cardiologist at an Inova facility. As an unphased trial, this study allows patients to contribute to innovative approaches in heart failure care.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on advising doctors about heart failure medications that are not currently prescribed, so it's best to discuss your specific situation with the trial coordinators.

What prior data suggests that this best practice advisory system is safe for heart failure patients?

Research has shown that electronic health record (EHR) tools, such as the Best Practice Advisory (BPA) system, are generally safe and can enhance care for heart failure patients. Studies have found that these tools help doctors follow treatment guidelines more effectively, leading to better patient outcomes.

One study discovered that EHR alerts for heart failure patients increased the use of recommended treatments within just 30 days. No strong evidence indicates harm from using these alerts, which primarily assist doctors in making better treatment decisions.

So far, reports of serious issues from using these BPA systems have not emerged. They are designed to assist healthcare providers and improve patient care by suggesting the right medications. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Most treatments for heart failure focus on medications, lifestyle changes, or surgeries to manage symptoms and improve heart function. However, researchers are excited about using Best Practice Advisory Alerts because they leverage electronic health records to enhance clinical decision-making in real-time. Unlike traditional approaches, these alerts pop up when healthcare providers are entering orders, potentially catching and addressing issues immediately. This method aims to improve the quality of care by providing timely guidance, which could lead to better outcomes for patients with heart failure.

What evidence suggests that this advisory system is effective for heart failure?

Research has shown that special alerts in electronic health records (EHR) can improve care for heart failure patients. In this trial, one group of participants will receive alerts when providers enter orders, while another group will receive usual care without alerts. These alerts increase the likelihood that doctors will follow heart failure treatment guidelines. Specifically, one study found that doctors using these alerts were more likely to perform important screenings, suggesting better management of heart failure. Evidence also shows that these EHR tools help doctors prescribe the right medications more consistently. This approach aims to improve patient outcomes by ensuring they receive the most effective treatments available. ^{1 6 7 8 9}

Who Is on the Research Team?

Mitchell Psotka, MD, PhD

Principal Investigator

Inova Health Care Services

Are You a Good Fit for This Trial?

This trial is for heart failure patients over 18 years old with a left ventricular ejection fraction of 40% or less, seen by a cardiologist at Inova clinics or hospitals. It's not for those who've opted out of EHR research, had a heart transplant, are on full doses of HFrEF meds, or in hospice care.

Inclusion Criteria

My heart's pumping ability is reduced.

Seen by a Cardiologist in an Inova clinic or Inova hospital setting

I am older than 18 years.

Exclusion Criteria

I am not currently receiving hospice care.

You have had a heart transplant before.

I am on the highest doses of all four key heart failure medications.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants are exposed to an electronic health record best practice advisory system to stimulate appropriate medication prescription for heart failure

30 days

Follow-up

Participants are monitored for safety and effectiveness after intervention

1 year

What Are the Treatments Tested in This Trial?

Interventions

• Best Practice Advisory using Electronic Health Record

Trial Overview The study tests if an electronic alert system helps doctors prescribe the right FDA-approved heart failure meds versus usual care without alerts. Patients will be randomly assigned to receive either the new alert system approach or continue with standard practices.

How Is the Trial Designed?

Group I: Alert when provider is entering orders Experimental Treatment 1 Intervention

Group II: No alert, usual care Active Control 1 Intervention

Who Is Running the Clinical Trial?

Inova Health Care Services

Lead Sponsor

Trials

80

Recruited

22,700+

Heart Failure Collaboratory

Collaborator

Trials

1

Recruited

5,000+

Published Research Related to This Trial

A study analyzed the electronic health record (EHR) usage of 548 heart failure patients accessed by 5113 healthcare providers, revealing extensive collaboration among providers during hospital stays.

The findings showed that EHR access involved large groups of providers, with an average of 87.9 providers per collaboration module, highlighting the potential for improved care coordination through better understanding of these interactions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Visualizing collaborative electronic health record usage for hospitalized patients with heart failure. Soulakis, ND., Carson, MB., Lee, YJ., et al.[2022]

A study involving 15,381 patients with chronic heart failure across 167 cardiology practices revealed low adherence to guideline-recommended adjunctive therapies, with only 7.3% receiving hydralazine/isosorbide dinitrate and 1.0% receiving pneumococcal vaccination.

Overall adherence to other adjunctive treatments varied but remained inadequate, highlighting significant gaps in the management of heart failure and the need for improved care processes and documentation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adherence to guideline-recommended adjunctive heart failure therapies among outpatient cardiology practices (findings from IMPROVE HF). Yancy, CW., Fonarow, GC., Albert, NM., et al.[2022]

Multidisciplinary teams using structured medication titration strategies have been shown to be more effective in managing heart failure than traditional methods that rely solely on clinician alerts and educational initiatives.

Remote monitoring technologies, such as invasive pressure monitoring and wearable devices, hold promise for early detection of heart failure worsening, but more real-world data is necessary to validate their effectiveness and establish treatment protocols.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The use of multidisciplinary teams, electronic health records tools, and technology to optimize heart failure population health. Martyn, T., Montgomery, RA., Estep, JD.[2022]

Participation in heart failure (HF) performance improvement registries, such as ADHERE and OPTIMIZE-HF, has led to significant enhancements in the use of guideline-recommended therapies for HF, improving patient care in both hospital and outpatient settings.

These registries have not only improved adherence to quality measures but have also resulted in better clinical outcomes for patients with HF, helping to reduce disparities in care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving quality of care and outcomes for heart failure. -Role of registries-. Fonarow, GC.[2022]

A tailored electronic health record (EHR) alert system did not significantly increase the overall prescription rates of guideline-directed medical therapies (GDMT) at discharge for patients hospitalized with acute heart failure, with only 34% of patients receiving GDMT in both alert and no alert groups.

However, the alert did lead to a significant increase in the prescription of mineralocorticoid receptor antagonists (MRAs), suggesting that while the overall impact was limited, targeted alerts can still improve specific aspects of treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Electronic health record alerts for management of heart failure with reduced ejection fraction in hospitalized patients: the PROMPT-AHF trial. Ghazi, L., Yamamoto, Y., Fuery, M., et al.[2023]

The PROMPT-HF trial is testing whether electronic health record (EHR) alerts can improve adherence to guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) among 1,310 patients, aiming to enhance treatment outcomes.

By providing tailored alerts that include patient-specific data, the trial seeks to determine if this approach can lead to higher rates of GDMT prescriptions and better clinical outcomes, such as reduced hospital readmissions and mortality, compared to usual care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rationale and design of a cluster-randomized pragmatic trial aimed at improving use of guideline directed medical therapy in outpatients with heart failure: PRagmatic trial of messaging to providers about treatment of heart failure (PROMPT-HF). Ghazi, L., Desai, NR., Simonov, M., et al.[2022]

The PRagmatic Trial Of Messaging to Providers about Treatment of Acute Heart Failure involved 1,012 hospitalized patients with heart failure with reduced ejection fraction (HFrEF) to test an electronic health record system that alerts providers about necessary but unprescribed guideline-directed medical therapy (GDMT).

The study aims to increase the prescription of GDMT at discharge, addressing the common issue of underutilization, which can lead to higher risks of cardiovascular death and hospital readmissions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pragmatic trial of messaging to providers about treatment of acute heart failure: The PROMPT-AHF trial. Ghazi, L., O'Connor, K., Yamamoto, Y., et al.[2023]

The HEARTFELT intervention significantly improved clinician adherence to self-management categories in heart failure care, as evidenced by a P-value of .000, indicating a strong effect after implementation.

While the intervention enhanced education and self-management support for patients, it did not show significant improvements in adherence to medical interventions, suggesting that further strategies may be needed to address this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical practice guideline adherence before and after implementation of the HEARTFELT (HEART Failure Effectiveness & Leadership Team) intervention. Dykes, PC., Acevedo, K., Boldrighini, J., et al.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9167063/

Electronic Health Records and Heart Failure - PMC There is evidence that specific EHR-based tools can improve adherence to evidence-based guidelines of HF care, patient self-management, and clinical outcomes.

2. ahajournals.org ahajournals.org/doi/10.1161/jaha.117.008158

Association of Electronic Health Record Use With Quality ... Our results suggest that EHR may not be sufficient to improve HF quality or related outcomes. Clinical Perspective. What Is New? •. Few ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S294991272300034X

Interacting with best practice advisory (BPA) notifications in ... Positively interacting with best practice advisory alerts is associated with 2.48 increased odds for screening of abdominal aortic aneurysm screening.

4. jacc.org jacc.org/doi/10.1016/j.jacc.2023.02.040

The EHR Has Exposed an Urgent Moral Imperative to ... Best practice alerts (BPAs) for heart failure that curtail deficiencies in knowledge and inertia can be built into the EHR with relative ease. These are low- ...

5. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2836552

Electronic Health Record Interventions to Reduce Risk of ... This systematic review and meta-analysis investigates whether electronic health record (EHR)–based interventions are associated with reduced ...

6. ahajournals.org ahajournals.org/doi/10.1161/CIRCOUTCOMES.122.009235

Implementation of an Electronic Health Records–Based ... We created a Best Practice Advisory (BPA) alert in our Epic EHR system, which displayed the patient's safe contrast limit along with CA-AKI ...

7. sciencedirect.com sciencedirect.com/science/article/pii/S0735109722044898

Electronic Alerts to Improve Heart Failure Therapy in ... This study sought to examine whether targeted and tailored electronic health record (EHR) alerts recommending GDMT in eligible patients with HFrEF improves GDMT ...

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7058493/

Heart Failure Management Innovation Enabled by Electronic ... In this article we describe how appropriate use of technologies offered by EHRs can help standardize CHF care, promote adherence to evidence-based guidelines, ...

9. acc.org acc.org/Latest-in-Cardiology/Journal-Scans/2022/04/02/13/27/Electronic-Alerts-to-Improve-HF-acc-2022

PROMPT-HF Trial: Electronic Alerts for HF Therapies Targeted and tailored EHR BPAs for outpatient HFrEF visits led to significantly higher rates of GDMT initiation at 30 days compared with usual care (no BPAs).