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)

Heart failure with reduced ejection fraction (HFrEF) is one of the most common chronic illnesses in the United States and carries significant risk of morbidity and mortality. Use of guideline-directed medical therapy (GDMT) for patients with HFrEF has been shown to dramatically improve outcomes, but...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:The American heart journal 2022-02, Vol.244, p.107-115
Hauptverfasser: Ghazi, Lama, Desai, Nihar R., Simonov, Michael, Yamamoto, Yu, O'Connor, Kyle D., Riello, Ralph J., Huang, Joanna, Olufade, Temitope, McDermott, James, Inzucchi, Silvio E., Velazquez, Eric J., Wilson, F. Perry, Ahmad, Tariq
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 115
container_issue
container_start_page 107
container_title The American heart journal
container_volume 244
creator Ghazi, Lama
Desai, Nihar R.
Simonov, Michael
Yamamoto, Yu
O'Connor, Kyle D.
Riello, Ralph J.
Huang, Joanna
Olufade, Temitope
McDermott, James
Inzucchi, Silvio E.
Velazquez, Eric J.
Wilson, F. Perry
Ahmad, Tariq
description Heart failure with reduced ejection fraction (HFrEF) is one of the most common chronic illnesses in the United States and carries significant risk of morbidity and mortality. Use of guideline-directed medical therapy (GDMT) for patients with HFrEF has been shown to dramatically improve outcomes, but adoption of these treatments remains generally low. Possible explanations for poor GDMT uptake include lack of knowledge about recommended management strategies and provider reluctance due to uncertainties regarding application of said guidelines to real-world practice. One way to overcome these barriers is by harnessing the electronic health record (EHR) to create patient-centered "best practice alerts" (BPAs) that can guide clinicians to prescribe appropriate medical therapies. If found to be effective, these low-cost interventions can be rapidly applied across large integrated healthcare systems. The PRagmatic Trial Of Messaging to Providers about Treatment of Heart Failure (PROMPT-HF) trial is a pragmatic, cluster randomized controlled trial designed to test the hypothesis that tailored and timely alerting of recommended GDMT in heart failure (HF) will result in greater adherence to guidelines when compared with usual care. PROMPT-HF has completed enrollment of 1,310 ambulatory patients with HFrEF cared for by 100 providers who were randomized to receive a BPA vs usual care. The BPA alerted providers to GDMT recommended for their patients and displayed current left ventricular ejection fraction (LVEF) along with the most recent blood pressure, heart rate, serum potassium and creatinine levels, and estimated glomerular filtration rate. It also linked to an order set customized to the patient that suggests medications within each GDMT class not already prescribed. Our goal is to examine whether tailored EHR-based alerting for outpatients with HFrEF will lead to higher rates of GDMT at 30 days post randomization when compared with usual care. Additionally, we are assessing clinical outcomes such as hospital readmissions and death between the alert versus usual care group. Trial Registration: Clinicaltrials.gov NCT04514458
doi_str_mv 10.1016/j.ahj.2021.11.010
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2601480152</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002870321004610</els_id><sourcerecordid>2601480152</sourcerecordid><originalsourceid>FETCH-LOGICAL-c424t-6b4920eca4b73bf8ce858335e3064a735f3fcb0aa98bffc4dfb241618a15488c3</originalsourceid><addsrcrecordid>eNp9ks1u1DAUhSMEokPhAdggS2zKIsFOnMQDK1RRilTU0aisrRvnJuMof9hOUXltXoAbpiCVBSvL9nfOtXxOFL0UPBFcFG-7BA5dkvJUJEIkXPBH0UbwbRkXpZSPow3nPI1VybOT6Jn3HW2LVBVPo5NMKq4El5vo5x6CnUbokcFYsxq9bUc2NQyY6Rcf0MWOLqbB_sCazQ7agQSGBWehZ2AHOoXA7DC76daOLVs8rvJ2sTX2dkRWW4cmEEaoNSQKB3Qw3zFLc5Ywkx2OwbPvNhzYAcEF1oDtF4fv2G7_cB4ZD-g9tOukMLHfQ2t0nkFFXkQhhIHsVvKBFzvb7a-_7G7iy4s3z6MnDfQeX9yvp9HXi48355fx1fWnz-cfrmIjUxniopLblKMBWZVZ1SiDKldZlmPGCwllljdZYyoOsFVV0xhZN1UqRSEUiFwqZbLT6OzoS8_8tqAPerDeYN_DiNPidVpwQUGIPCX09T9oNy2OYlmp1Y5y2xIljpRxk_cOGz07O4C704LrtRG609QIvTZCC6GpEaR5de-8VJTAX8WfChDw_gggfcWtRae9oUQMHoPT9WT_Y_8LSBvLUw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2615482869</pqid></control><display><type>article</type><title>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)</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><source>ProQuest Central UK/Ireland</source><creator>Ghazi, Lama ; Desai, Nihar R. ; Simonov, Michael ; Yamamoto, Yu ; O'Connor, Kyle D. ; Riello, Ralph J. ; Huang, Joanna ; Olufade, Temitope ; McDermott, James ; Inzucchi, Silvio E. ; Velazquez, Eric J. ; Wilson, F. Perry ; Ahmad, Tariq</creator><creatorcontrib>Ghazi, Lama ; Desai, Nihar R. ; Simonov, Michael ; Yamamoto, Yu ; O'Connor, Kyle D. ; Riello, Ralph J. ; Huang, Joanna ; Olufade, Temitope ; McDermott, James ; Inzucchi, Silvio E. ; Velazquez, Eric J. ; Wilson, F. Perry ; Ahmad, Tariq</creatorcontrib><description>Heart failure with reduced ejection fraction (HFrEF) is one of the most common chronic illnesses in the United States and carries significant risk of morbidity and mortality. Use of guideline-directed medical therapy (GDMT) for patients with HFrEF has been shown to dramatically improve outcomes, but adoption of these treatments remains generally low. Possible explanations for poor GDMT uptake include lack of knowledge about recommended management strategies and provider reluctance due to uncertainties regarding application of said guidelines to real-world practice. One way to overcome these barriers is by harnessing the electronic health record (EHR) to create patient-centered "best practice alerts" (BPAs) that can guide clinicians to prescribe appropriate medical therapies. If found to be effective, these low-cost interventions can be rapidly applied across large integrated healthcare systems. The PRagmatic Trial Of Messaging to Providers about Treatment of Heart Failure (PROMPT-HF) trial is a pragmatic, cluster randomized controlled trial designed to test the hypothesis that tailored and timely alerting of recommended GDMT in heart failure (HF) will result in greater adherence to guidelines when compared with usual care. PROMPT-HF has completed enrollment of 1,310 ambulatory patients with HFrEF cared for by 100 providers who were randomized to receive a BPA vs usual care. The BPA alerted providers to GDMT recommended for their patients and displayed current left ventricular ejection fraction (LVEF) along with the most recent blood pressure, heart rate, serum potassium and creatinine levels, and estimated glomerular filtration rate. It also linked to an order set customized to the patient that suggests medications within each GDMT class not already prescribed. Our goal is to examine whether tailored EHR-based alerting for outpatients with HFrEF will lead to higher rates of GDMT at 30 days post randomization when compared with usual care. Additionally, we are assessing clinical outcomes such as hospital readmissions and death between the alert versus usual care group. Trial Registration: Clinicaltrials.gov NCT04514458</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2021.11.010</identifier><identifier>PMID: 34808104</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Best practice ; Blood pressure ; Cardiology ; Chronic illnesses ; Clinical outcomes ; Clusters ; Congestive heart failure ; Creatinine ; Drug dosages ; Ejection fraction ; Electronic health records ; Electronic medical records ; Enrollments ; Glomerular filtration rate ; Guidelines ; Health care ; Health services ; Heart failure ; Heart Failure - drug therapy ; Heart rate ; Humans ; Internal medicine ; Intervention ; Medicine ; Morbidity ; Outpatients ; Patients ; Potassium ; Randomization ; Stroke Volume ; United States ; Ventricle ; Ventricular Dysfunction, Left ; Ventricular Function, Left</subject><ispartof>The American heart journal, 2022-02, Vol.244, p.107-115</ispartof><rights>2021</rights><rights>Copyright © 2021. Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited Feb 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c424t-6b4920eca4b73bf8ce858335e3064a735f3fcb0aa98bffc4dfb241618a15488c3</citedby><cites>FETCH-LOGICAL-c424t-6b4920eca4b73bf8ce858335e3064a735f3fcb0aa98bffc4dfb241618a15488c3</cites><orcidid>0000-0002-9930-3575 ; 0000-0002-2633-2412 ; 0000-0002-8323-8676 ; 0000-0003-2245-7477</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2615482869?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34808104$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ghazi, Lama</creatorcontrib><creatorcontrib>Desai, Nihar R.</creatorcontrib><creatorcontrib>Simonov, Michael</creatorcontrib><creatorcontrib>Yamamoto, Yu</creatorcontrib><creatorcontrib>O'Connor, Kyle D.</creatorcontrib><creatorcontrib>Riello, Ralph J.</creatorcontrib><creatorcontrib>Huang, Joanna</creatorcontrib><creatorcontrib>Olufade, Temitope</creatorcontrib><creatorcontrib>McDermott, James</creatorcontrib><creatorcontrib>Inzucchi, Silvio E.</creatorcontrib><creatorcontrib>Velazquez, Eric J.</creatorcontrib><creatorcontrib>Wilson, F. Perry</creatorcontrib><creatorcontrib>Ahmad, Tariq</creatorcontrib><title>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)</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Heart failure with reduced ejection fraction (HFrEF) is one of the most common chronic illnesses in the United States and carries significant risk of morbidity and mortality. Use of guideline-directed medical therapy (GDMT) for patients with HFrEF has been shown to dramatically improve outcomes, but adoption of these treatments remains generally low. Possible explanations for poor GDMT uptake include lack of knowledge about recommended management strategies and provider reluctance due to uncertainties regarding application of said guidelines to real-world practice. One way to overcome these barriers is by harnessing the electronic health record (EHR) to create patient-centered "best practice alerts" (BPAs) that can guide clinicians to prescribe appropriate medical therapies. If found to be effective, these low-cost interventions can be rapidly applied across large integrated healthcare systems. The PRagmatic Trial Of Messaging to Providers about Treatment of Heart Failure (PROMPT-HF) trial is a pragmatic, cluster randomized controlled trial designed to test the hypothesis that tailored and timely alerting of recommended GDMT in heart failure (HF) will result in greater adherence to guidelines when compared with usual care. PROMPT-HF has completed enrollment of 1,310 ambulatory patients with HFrEF cared for by 100 providers who were randomized to receive a BPA vs usual care. The BPA alerted providers to GDMT recommended for their patients and displayed current left ventricular ejection fraction (LVEF) along with the most recent blood pressure, heart rate, serum potassium and creatinine levels, and estimated glomerular filtration rate. It also linked to an order set customized to the patient that suggests medications within each GDMT class not already prescribed. Our goal is to examine whether tailored EHR-based alerting for outpatients with HFrEF will lead to higher rates of GDMT at 30 days post randomization when compared with usual care. Additionally, we are assessing clinical outcomes such as hospital readmissions and death between the alert versus usual care group. Trial Registration: Clinicaltrials.gov NCT04514458</description><subject>Best practice</subject><subject>Blood pressure</subject><subject>Cardiology</subject><subject>Chronic illnesses</subject><subject>Clinical outcomes</subject><subject>Clusters</subject><subject>Congestive heart failure</subject><subject>Creatinine</subject><subject>Drug dosages</subject><subject>Ejection fraction</subject><subject>Electronic health records</subject><subject>Electronic medical records</subject><subject>Enrollments</subject><subject>Glomerular filtration rate</subject><subject>Guidelines</subject><subject>Health care</subject><subject>Health services</subject><subject>Heart failure</subject><subject>Heart Failure - drug therapy</subject><subject>Heart rate</subject><subject>Humans</subject><subject>Internal medicine</subject><subject>Intervention</subject><subject>Medicine</subject><subject>Morbidity</subject><subject>Outpatients</subject><subject>Patients</subject><subject>Potassium</subject><subject>Randomization</subject><subject>Stroke Volume</subject><subject>United States</subject><subject>Ventricle</subject><subject>Ventricular Dysfunction, Left</subject><subject>Ventricular Function, Left</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9ks1u1DAUhSMEokPhAdggS2zKIsFOnMQDK1RRilTU0aisrRvnJuMof9hOUXltXoAbpiCVBSvL9nfOtXxOFL0UPBFcFG-7BA5dkvJUJEIkXPBH0UbwbRkXpZSPow3nPI1VybOT6Jn3HW2LVBVPo5NMKq4El5vo5x6CnUbokcFYsxq9bUc2NQyY6Rcf0MWOLqbB_sCazQ7agQSGBWehZ2AHOoXA7DC76daOLVs8rvJ2sTX2dkRWW4cmEEaoNSQKB3Qw3zFLc5Ywkx2OwbPvNhzYAcEF1oDtF4fv2G7_cB4ZD-g9tOukMLHfQ2t0nkFFXkQhhIHsVvKBFzvb7a-_7G7iy4s3z6MnDfQeX9yvp9HXi48355fx1fWnz-cfrmIjUxniopLblKMBWZVZ1SiDKldZlmPGCwllljdZYyoOsFVV0xhZN1UqRSEUiFwqZbLT6OzoS8_8tqAPerDeYN_DiNPidVpwQUGIPCX09T9oNy2OYlmp1Y5y2xIljpRxk_cOGz07O4C704LrtRG609QIvTZCC6GpEaR5de-8VJTAX8WfChDw_gggfcWtRae9oUQMHoPT9WT_Y_8LSBvLUw</recordid><startdate>202202</startdate><enddate>202202</enddate><creator>Ghazi, Lama</creator><creator>Desai, Nihar R.</creator><creator>Simonov, Michael</creator><creator>Yamamoto, Yu</creator><creator>O'Connor, Kyle D.</creator><creator>Riello, Ralph J.</creator><creator>Huang, Joanna</creator><creator>Olufade, Temitope</creator><creator>McDermott, James</creator><creator>Inzucchi, Silvio E.</creator><creator>Velazquez, Eric J.</creator><creator>Wilson, F. Perry</creator><creator>Ahmad, Tariq</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9930-3575</orcidid><orcidid>https://orcid.org/0000-0002-2633-2412</orcidid><orcidid>https://orcid.org/0000-0002-8323-8676</orcidid><orcidid>https://orcid.org/0000-0003-2245-7477</orcidid></search><sort><creationdate>202202</creationdate><title>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)</title><author>Ghazi, Lama ; Desai, Nihar R. ; Simonov, Michael ; Yamamoto, Yu ; O'Connor, Kyle D. ; Riello, Ralph J. ; Huang, Joanna ; Olufade, Temitope ; McDermott, James ; Inzucchi, Silvio E. ; Velazquez, Eric J. ; Wilson, F. Perry ; Ahmad, Tariq</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c424t-6b4920eca4b73bf8ce858335e3064a735f3fcb0aa98bffc4dfb241618a15488c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Best practice</topic><topic>Blood pressure</topic><topic>Cardiology</topic><topic>Chronic illnesses</topic><topic>Clinical outcomes</topic><topic>Clusters</topic><topic>Congestive heart failure</topic><topic>Creatinine</topic><topic>Drug dosages</topic><topic>Ejection fraction</topic><topic>Electronic health records</topic><topic>Electronic medical records</topic><topic>Enrollments</topic><topic>Glomerular filtration rate</topic><topic>Guidelines</topic><topic>Health care</topic><topic>Health services</topic><topic>Heart failure</topic><topic>Heart Failure - drug therapy</topic><topic>Heart rate</topic><topic>Humans</topic><topic>Internal medicine</topic><topic>Intervention</topic><topic>Medicine</topic><topic>Morbidity</topic><topic>Outpatients</topic><topic>Patients</topic><topic>Potassium</topic><topic>Randomization</topic><topic>Stroke Volume</topic><topic>United States</topic><topic>Ventricle</topic><topic>Ventricular Dysfunction, Left</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ghazi, Lama</creatorcontrib><creatorcontrib>Desai, Nihar R.</creatorcontrib><creatorcontrib>Simonov, Michael</creatorcontrib><creatorcontrib>Yamamoto, Yu</creatorcontrib><creatorcontrib>O'Connor, Kyle D.</creatorcontrib><creatorcontrib>Riello, Ralph J.</creatorcontrib><creatorcontrib>Huang, Joanna</creatorcontrib><creatorcontrib>Olufade, Temitope</creatorcontrib><creatorcontrib>McDermott, James</creatorcontrib><creatorcontrib>Inzucchi, Silvio E.</creatorcontrib><creatorcontrib>Velazquez, Eric J.</creatorcontrib><creatorcontrib>Wilson, F. Perry</creatorcontrib><creatorcontrib>Ahmad, Tariq</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ghazi, Lama</au><au>Desai, Nihar R.</au><au>Simonov, Michael</au><au>Yamamoto, Yu</au><au>O'Connor, Kyle D.</au><au>Riello, Ralph J.</au><au>Huang, Joanna</au><au>Olufade, Temitope</au><au>McDermott, James</au><au>Inzucchi, Silvio E.</au><au>Velazquez, Eric J.</au><au>Wilson, F. Perry</au><au>Ahmad, Tariq</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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)</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2022-02</date><risdate>2022</risdate><volume>244</volume><spage>107</spage><epage>115</epage><pages>107-115</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><abstract>Heart failure with reduced ejection fraction (HFrEF) is one of the most common chronic illnesses in the United States and carries significant risk of morbidity and mortality. Use of guideline-directed medical therapy (GDMT) for patients with HFrEF has been shown to dramatically improve outcomes, but adoption of these treatments remains generally low. Possible explanations for poor GDMT uptake include lack of knowledge about recommended management strategies and provider reluctance due to uncertainties regarding application of said guidelines to real-world practice. One way to overcome these barriers is by harnessing the electronic health record (EHR) to create patient-centered "best practice alerts" (BPAs) that can guide clinicians to prescribe appropriate medical therapies. If found to be effective, these low-cost interventions can be rapidly applied across large integrated healthcare systems. The PRagmatic Trial Of Messaging to Providers about Treatment of Heart Failure (PROMPT-HF) trial is a pragmatic, cluster randomized controlled trial designed to test the hypothesis that tailored and timely alerting of recommended GDMT in heart failure (HF) will result in greater adherence to guidelines when compared with usual care. PROMPT-HF has completed enrollment of 1,310 ambulatory patients with HFrEF cared for by 100 providers who were randomized to receive a BPA vs usual care. The BPA alerted providers to GDMT recommended for their patients and displayed current left ventricular ejection fraction (LVEF) along with the most recent blood pressure, heart rate, serum potassium and creatinine levels, and estimated glomerular filtration rate. It also linked to an order set customized to the patient that suggests medications within each GDMT class not already prescribed. Our goal is to examine whether tailored EHR-based alerting for outpatients with HFrEF will lead to higher rates of GDMT at 30 days post randomization when compared with usual care. Additionally, we are assessing clinical outcomes such as hospital readmissions and death between the alert versus usual care group. Trial Registration: Clinicaltrials.gov NCT04514458</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34808104</pmid><doi>10.1016/j.ahj.2021.11.010</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-9930-3575</orcidid><orcidid>https://orcid.org/0000-0002-2633-2412</orcidid><orcidid>https://orcid.org/0000-0002-8323-8676</orcidid><orcidid>https://orcid.org/0000-0003-2245-7477</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0002-8703
ispartof The American heart journal, 2022-02, Vol.244, p.107-115
issn 0002-8703
1097-6744
language eng
recordid cdi_proquest_miscellaneous_2601480152
source MEDLINE; Access via ScienceDirect (Elsevier); ProQuest Central UK/Ireland
subjects Best practice
Blood pressure
Cardiology
Chronic illnesses
Clinical outcomes
Clusters
Congestive heart failure
Creatinine
Drug dosages
Ejection fraction
Electronic health records
Electronic medical records
Enrollments
Glomerular filtration rate
Guidelines
Health care
Health services
Heart failure
Heart Failure - drug therapy
Heart rate
Humans
Internal medicine
Intervention
Medicine
Morbidity
Outpatients
Patients
Potassium
Randomization
Stroke Volume
United States
Ventricle
Ventricular Dysfunction, Left
Ventricular Function, Left
title 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)
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-23T04%3A17%3A33IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Rationale%20and%20design%20of%20a%20cluster-randomized%20pragmatic%20trial%20aimed%20at%20improving%20use%20of%20guideline%20directed%20medical%20therapy%20in%20outpatients%20with%20heart%20failure:%20PRagmatic%20trial%20of%20messaging%20to%20providers%20about%20treatment%20of%20heart%20failure%20(PROMPT-HF)&rft.jtitle=The%20American%20heart%20journal&rft.au=Ghazi,%20Lama&rft.date=2022-02&rft.volume=244&rft.spage=107&rft.epage=115&rft.pages=107-115&rft.issn=0002-8703&rft.eissn=1097-6744&rft_id=info:doi/10.1016/j.ahj.2021.11.010&rft_dat=%3Cproquest_cross%3E2601480152%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2615482869&rft_id=info:pmid/34808104&rft_els_id=S0002870321004610&rfr_iscdi=true