A Pilot Study to Increase Utilization of GDMT in Patients With HFrEF

Study Overview
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Brief Summary
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The purpose of this study is to test a clinical decision support (CDS) tool that provides clinicians (cardiologists and nurse practitioners) medication recommendations regarding guideline directed medical therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF).

Detailed Description
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The purpose of our study is to test whether home blood pressure monitoring (HBPM) with clinical-decision support (CDS) will optimize the use of GDMT in patients with HFrEF. HBPM allows cardiologists and NPs to monitor patients outside the clinical setting so that GDMT can be safely initiated and up-titrated. The CDS employs HBPM and electronic medical record (EMR) data to implement the ACC/AHA HF guidelines and provides cardiologists and NPs with GDMT recommendations.

Official Title
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A Pilot Study to Increase Utilization of Guideline Directed Medical Therapy in Patients With HFrEF

Conditions
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Heart Failure

Intervention / Treatment
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* Other: Using a clinical decision software to provide specific recommendation of a medication at a certain dosage


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of HFrEF (left ejection fraction < 40%, assessed by transthoracic echo, cardiac MRI, cardiac SPECT) within the past year. New York Heart Association (NYHA) class II-III at most recent screening assessment. GDMT composite score of less than or equal to 50% at baseline Exclusion Criteria: Previous contraindication to beta blockers, ACE inhibitors, and/or ARB. Baseline creatinine > 2 mg/dl or potassium level at baseline > 5 mEq/L or eGFR <30 mL/min/1.73 m2. Baseline systolic blood pressure < 100 mmHg. Concomitant use of ACE, ARB, and/or ARNI Polycystic kidney disease History of angioedema History of or currently on a transplant list Left ventricular assist device Uncontrolled asthma Severe COPD Cirrhosis Currently receiving hospice or comfort care Patient not proficient with written and spoken English Patient has diminished decision making capability History of non-compliance

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Enrolled Subjects<br>Test a clinical decision support (CDS) tool that provides clinicians (cardiologists and nurse practitioners) recommendations regarding guideline directed medical therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF). | Other: Using a clinical decision software to provide specific recommendation of a medication at a certain dosage<br>* During routine follow-up, clinicians, cardiologists, and NPs who have a scheduled visit with an enrolled patient will be offered a medication recommendation. The medication recommendation will be generated by the clinical decision support tool. The software will advise the cardiologist whether an HF medication should be initiated, discontinued, or the dosage titrated and if the patient requires labs. In addition, the software, or decision engine (DE), will be run once weekly and every time the patient has new basic metabolic panel results. If the patient is admitted to the hospital, skilled nursing facility, or inpatient rehabilitation unit, the use of DE will be placed on hold until the patient is discharged and at home.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patients at or above 50% target dose of GDMT in HFrEF patients | Change in the proportion of patients at or above 50% target dose of GDMT in | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of accepted medication recommendations | The percentage of DE output medication recommendations in which the clinician accepts alerts | 6 months |