PROMPTing Change Through Clever Electronic Health Record Alerts
Volume 16, Issue 1
Heart failure continues to be a mortal illness, owing to its high prevalence and an aging US population. Unfortunately, another contributing factor the high residual mortality with heart failure stems from the widespread underutilization of guideline-directed medical therapies (GDMT).
For instance, mineralocorticoid receptor antagonists, which were first studied in heart failure in 1999, are still used in only half of eligible patients despite having a Class I, level-of-evidence A recommendation from all international heart failure societies.
In this week’s issue of Talking Therapeutics, we review the recently published PROMPT-HF study, in which researchers sought to address this critical medical problem by leveraging the power of the electronic health record (EHR).
Point 1: Targeted Alerts Are Effective
PROMPT-HF was a comparative effectiveness trial in which 100 providers were randomized to receive an alert via EHR or usual care.
“The alert notified providers of individualized GDMT recommendations along with patient characteristics,” researchers said. “The primary outcome was an increase in the number of GDMT classes prescribed at 30 days post-randomization.”
Just over 1300 patients with heart failure with reduced ejection fraction were enrolled. At baseline, most patients received beta blockers (84%) or renin-angiotensin-aldosterone system inhibitors (71%). Only 29% of patients were being treated with a mineralocorticoid receptor antagonist—a number which really drives home the message that these medications are grossly underutilized.
The number of prescribed GDMTs increased in 176 of 685 (26%) patients in the alert group vs 117 of 625 (19%) patients receiving usual care (adjusted relative risk: 1.41; 95% CI: 1.03-1.93; P=.03).
“The number of patients needed to alert to result in an increase in addition of GDMT classes was 14,” authors concluded.
Point 2: Targeted Alerts Are Well Received
Most providers (79%) who received alerts felt the alert enabled them to better prescribe medical therapy to their patients. This widespread acceptance for the intervention likely stems from the targeted nature of the alerts.
Many of the alerts currently programmed into EHRs are not targeted and function more like spam, showing up in situations where they’re not applicable. This leads to alert fatigue for providers and decreases the effectiveness of the alert.
In PROMPT-HF, providers participated in focus groups to offer feedback on the alert’s “design, user friendliness, and hindrance to workflow.” The alert contained pertinent clinical data and guided the user to select eligible GDMT tailored for that specific patient.
Given the success of this intervention in PROMPT-HF, additional research evaluating target EHR alerts in other disease states appears warranted.
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