Implementation of a clinical decision support alert to prevent use of intravenous β-blockers and nondihydropyridine calcium channel blockers in hospitalized patients with acute decompensated heart failure.

Abstract

Intravenous (IV) β-blockers (BBs) and nondihydropyridine calcium channel blockers (NDCCBs) are harmful in patients with acute decompensated heart failure (ADHF), but they are commonly used for rate control in atrial fibrillation (AF). This study evaluated the implementation of a clinical decision support (CDS) alert in the electronic health record (EHR) to prevent the use of these agents for AF in patients with ADHF, as well as results from the alert's continuous quality improvement. This was a single-center, retrospective, quasi-experimental pre/post analysis of hospitalized adult patients with an ejection fraction of less than 40% documented during their encounter. Groups corresponding to encounters before and after introduction of the alert were compared, and the first version of the alert was compared to its second version that was refined by iterative design. For all patient hospital encounters, the rate of IV BB and NDCCB orders decreased in the period after alert implementation from 16.2% to 12% (P < 0.001). The alert's override rate decreased from 83.8% for the first version to 70.1% after iterative design (P = 0.015). This study demonstrates that a CDS alert can be used in the EHR to reduce the use of potentially harmful IV BBs and NDCCBs in patients with ADHF for rate control. User compliance with the alert was improved by applying human factors design principles and iterative design during continuous quality improvement.