PROMPT-HF

Heart failure (HF) is the major cause of healthcare expenditure, morbidity, and mortality in the United States. Without a doubt, it is a major health problem to the country today. However, clinical data suggest that pharmacological therapies lead to dramatic improvements in survival and hospitalization rates in patients with heart failure with reduced ejection fraction (HFrEF). That being said, data over the last 30 years shows a lack of evidence-based therapies at levels noted in clinical trials, despite aggressive recommendations from leaders in the field. In fact, our pilot data across the Yale New Haven Health System confirms this, showing almost identical use of evidence based heart failure therapies as noted in the most current and comprehensive registry—CHAMP-HF.

This is the problem that PROMPT-HF Outpatient seeks to address. Although it remains unclear as to why many patients with HFrEF are not on evidence-based therapies, it could be due to a lack of knowledge of available therapies by clinicians. 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.

Through a randomized controlled trial across outpatient clinics across the Yale New Haven Health System, the study will 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 by a grant from AstraZeneca