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TOPLINE:

An electronic decision support tool may increase the prescription of guideline–directed medical therapy for patients with acute heart failure (AHF) in emergency departments (EDs), with no serious adverse events (SAEs) within 30 days among very low-risk patients who are discharged.

METHODOLOGY:

• The researchers conducted a pilot study involving 234 patients with AHF discharged from two large urban EDs in Northern California from January 2023 to July 2023 to assess the feasibility and safety of a passive electronic alert system.
• The study utilized a two-tiered clinical decision support system: an 'AHF Banner' to nudge providers and an opt-in 'AHF report' offering tailored medical recommendations and personalized 30-day risk estimates using the STRIDE-HF risk tool for SAEs.
• The researchers assessed active prescriptions for beta-blockers (BBs), renin-angiotensin receptor system inhibitors (RASis), sodium-glucose transport protein 2 inhibitors (SGLT2is), and mineralocorticoid receptor antagonists (MRAs) at ED arrival, as well as the initiation of new classes within 72 hours of discharge.
• Prior to the launch of the decision support tool, ED clinicians received two 30-minute education sessions on AHF care and incorporating the tool into standard workflows.

• Overall, 21.8% had HF with reduced ejection fraction (HFrEF), 9.0% had HF with mildly reduced ejection fraction (HFmrEF), and 53.8% had HF with preserved ejection fraction (HFpEF).
• At ED arrival, 68.6%, 66.7%, 25.5%, and 19.6% patients with HFrEF were on a RASi, a BB, an SGLT2i, and an MRA, respectively. In contrast, 42.9%, 66.7%, 14.3%, and 4.8% patients with HFmrEF were on a RASi, a BB, an SGLT2i, and an MRA, respectively. An SGLT2i was the most prescribed new medication at ED discharge, with nearly a 10% increase in the proportion of patients with an active prescription.
• Among the 126 patients with HFpEF, only 4.8% were on an SGLT2i at ED arrival, and no new prescriptions for this medication class were issued at discharge.
• The researchers found no 30-day SAEs, including death, cardiopulmonary resuscitation, balloon-pump insertion, intubation, initiation of dialysis, myocardial infarction, or coronary revascularization, among the 51 patients discharged with a very low predicted risk for HF.

IN PRACTICE:

"Among a cohort of patients with AHF treated and discharged from an ED or observation unit, ongoing treatment with GDMT [guideline–directed medical therapy] among patients with HFrEF and HFmEF was sub-optimal.Our findings suggest that ED initiation is possible and that an EHR [ electronic health record]-based alert, combined with provider education and appropriate identification of low-risk patients who are safe for discharge, may be useful to address treatment gaps," the authors wrote.

SOURCE:

The study was led by Dana R. Sax, The Permanente Medical Group, Oakland, and Kaiser Permanente Northern California Division of Research, Pleasanton, California. It was published online on July 25, 2024, in ESC Heart Failure.

LIMITATIONS: 

The limited number of patients with HFrEF and HFmrEF in this study and the overestimation of the proportion of HFpEF cases might have affected the study findings.

DISCLOSURES:The authors did not disclose any funding information or conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.