A randomized controlled trial of an electronic health record alert (EHR) reporting the risk of one-year mortality in patients with heart failure (HF) did not result in significant differences in clinical outcome or intake. decision of clinicians. Dr Tariq Ahmad, associate professor of medicine at Yale University, and principal investigator of the trial, presented the results of the risk assessment trial and its impact on clinical decision-making and outcomes in insufficiency (REVEAL-HF) during the 2021 American Heart Association Scientific Sessions. Late Breaking Science Session on improving healthcare delivery through digital health and automated data.

The tools for predicting the risk of HF are plentiful, but rarely used in the clinic because they are not easily integrated into the clinician’s workflow. Their effects on clinical decision making and outcomes have never been evaluated in a randomized process. Practitioners caring for IC inpatients at four Yale University affiliated hospitals were randomized to receive or not receive a visual EHR alert highlighting a patient’s risk of mortality at one year. The primary endpoint was a composite endpoint of all-cause mortality and readmission to hospital.

A total of 3,124 patients were randomized, mean age 77 years, 51% female, 20% black, mean ejection fraction (EF) 55% and 28-29% with EF

By moderating the session, Dr Harriette Van Spall, associate professor of medicine at McMaster University, hypothesized the reasons for the zero result, including a large proportion of low-risk patients, for whom the alert may not change management, a high proportion of ‘CI with preserved EF, which has limited treatment options, FSD alert fatigue, and the potential lack of treatment effect derived from the risk score.

Dr Ahmad notes “We have seen time and time again in heart failure that measurements alone, without guidance, do not change the results. ESCAPE has shown this for pulmonary arterial catheters, GUIDE-IT for NT-proBNP, and now REVEAL-HF for risk scores. The results highlight a “need to be more prescriptive in heart failure where guidelines are separated from a true risk assessment”.

Disclosure of the patients’ annualized risk of HF did not change the results. Ongoing research into the appropriate and effective implementation of EHR in HF care is needed, such as the upcoming PROMPT-HF trial led by Dr. Ahmad and colleagues in which EHR is used to optimize the medical management of the IC.1

Dr Mark Belkin is correspondent for CardioNerds, a DocWire News content partner. Read more of their contributions by visiting their DocWire News archive page. Follow him on Twitter @MarkBelkinMD.

The references

  1. Ghazi L, Desai NR, Simonov M et al. Rationale and Design of a Pragmatic, Cluster Randomized Trial to Improve the Use of Guideline-Driven Medical Therapy in Ambulatory Heart Failure Patients: Provider Message PRagmatic Trial on Heart Failure Treatment ( PROMPT-HF). Am heart J. 2021; doi: doi.org/10.1016/j.ahj.2021.11.010.

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