When a patient is hospitalized for sudden worsening of heart failure symptoms, providers need to act fast. Known as Acute Heart Failure (AHF), this is the most common cause of hospital admission in the United States and Western Europe, and accounts for a large percentage of total health care expenditures. Mortality rates in AHF patients are higher than most cancers. Prescribing evidence-based medications reduces mortality and hospital readmission rates and improves quality of life; however, this is seldom practiced. Tariq Ahmad, MD, MPH, associate professor, and chief of the Heart Failure Program, launched a clinical trial with Nihar Desai, MD, MPH, F. Perry Wilson, MD, and colleagues to give providers targeted recommendations about their acute heart failure patients about guideline-directed medical therapies (GDMT).
The randomized controlled trial PROMPT-AHF enrolled 1,012 patients with acute heart failure with reduced ejection fraction (HFrEF) across the Yale New Haven Health System, one of the largest integrated academic health systems in the country. The research team programmed an alert into the electronic health record that provided personalized medication recommendations for patients. This alert was similar to a prior study in outpatient clinics done by this study team where the impact of this alert was dramatic on improvements in prescription of appropriate therapies.
“We wanted to see if that approach can also be used in the inpatient setting where patients are most vulnerable, but clinicians also have the most opportunity to start appropriate therapies,” said Ahmad.
For the PROMPT-AHF clinical trial, the research team programmed an alert into the electronic health record. Using a preprogramed algorithm, the software analyzed data and provide personalized recommendations for the patient. Ahmad will present research as a late-breaking clinical trial during the 2023 European Society of Cardiology Heart Failure Association annual meeting.
We wanted to see if that approach can also be used in the inpatient setting where patients are most vulnerable, but clinicians also have the most opportunity to start appropriate therapies.
Tariq Ahmad, MD, MPH
“Our heart failure team prioritizes bringing real evidence to quality improvement efforts. This field has suffered from a lack of randomized data, which is the basis of much decision-making in medicine. Our prior research has been groundbreaking as we have been the first to perform pragmatic randomized controlled trials on interventions that previously were not expected to meet this bar of evidence. As a result, several other health systems have reached out to us to replicate this approach with the long-term goal of implementing truly evidence-based interventions nationwide,” said Ahmad.
The 2023 Heart Failure Association annual meeting will be held May 20-May 23 in Prague, Czech Republic.