Abstract 10401: Development and Pilot Implementation of Two Targeted Approaches to Ambulatory Clinical Decision Support for Cardiologists to Optimize Medical Therapy for Heart Failure

Abstract

Introduction: Shortfalls in prescribing of proven therapies for patients with heart failure and reduced ejection fraction (HFrEF), particularly for mineralocorticoid receptor antagonists (MRA), account for several thousand preventable deaths per year nationwide. Electronic clinical decision support (CDS) is a potential low-cost and scalable solution to improve prescribing, but optimal timing and format of CDS tools are unknown. Objective: We developed two CDS interventions to inform cardiologists of gaps in MRA therapy for patients with HFrEF and without contraindication to MRA therapy: 1) a best practice alert (BPA) that notifies cardiologists at the time of patient visit, and 2) an automated in-basket message that allows for review between visits. Methods: We designed CDS tools using an established CDS framework and findings from semi-structured interviews with cardiologists. We then pilot-tested both CDS tools at two cardiology practices for 12 weeks in a cross-over design, and further enhanced them based on additional semi-structured interviews. Results: Based on pilot testing (n=596 patients) and semi-structured interviews (n=11 cardiologists), in-basket messages were modified to reduce the number of patients listed, include future visits, and list date of next visit. The BPA was modified to improve noticeability, reduce extraneous information on guidelines, and include key information on contraindications. Final CDS interventions after incorporation of feedback are depicted in the Figure. Conclusions: Pilot testing and semi-structured interviews were instrumental in the development of CDS interventions and should be employed for other similar studies. We will compare the effectiveness of the BPA vs the in-basket message vs usual care on the primary outcome of MRA prescribing in The BETTER CARE-HF trial (Building Electronic Tools to Enhance and Reinforce CArdiovascular REcommendations for Heart Failure) (Clinicaltrials.gov NCT05275920)