PROMPT-HF Inpatient

Heart failure (HF) is the major cause of healthcare expenditure, morbidity, and mortality in the United States. In the United States, heart failure is the primary diagnosis for approximately 1 million and a secondary diagnosis in another 2 million hospitalizations annually. In fact, inpatient admissions account for more than half of HF healthcare expenditure. However, data from several registries over the last three decades has failed to see use of evidence-based therapies at levels noted in clinical trials, despite aggressive recommendations by leaders in the field.

Although it remains unclear as to why many patients with HF reduced ejection fraction (HFrEF) are not on evidence-based therapies, especially post hospital discharge, it could be hypothesized that this is due to a lack of knowledge or providers making individualized decisions about their patients. A simple way to test these hypotheses is to examine whether electronic health record (EHR) based "best practice advisories" (BPAs) can increase use of evidence based therapies. If found to be effective, these low cost interventions can be rapidly applied across large healthcare systems.

Similar to PROMPT-HF Outpatient, PROMPT-HF Inpatient uses a randomized controlled trial to compare the effectiveness of an EHR BPA system that informs physicians of evidence-based medications to prescribe for eligible patients with HFrEF with a usual care group which receives no alert. Between these groups, the primary outcome observed will be the proportion of patients with HFrEF with an increase in prescribed evidence-based medical therapies (beta-blockers, ACE-I/ARB/ARNI, MRA, SGLT2i). Other outcomes observed will include the proportion of patients prescribed each class of evidence-based medication, the percent of filled prescriptions as assessed by Sure Scripts, medication doses, 30-day hospital admission rates, 30-day all-cause ED visits, one year all-cause mortality, and 6 month total healthcare cost.

This study is sponsored in part by a grant from Astrazeneca