Provider Notification for High B-type Natriuretic Peptide Values

Study Overview
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Brief Summary
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This proposal examines use of a clinical reminder to the primary provider of patient with a high B type natriuretic peptide but no prior imaging. Electrical Medical Record-based Intervention to Determine whether Clinical Reminders Improve Heart Failure Management in Patients with High BNP Values and Unknown LVEF.

Detailed Description
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Rationale: B type natriuretic peptide is known to be elevated (> 100 pg/ml) in patients with heart failure. Furthermore, treatments are available to improve survival and reduce hospitalization if the left ventricular ejection fraction (LVEF) is < 40%. Accordingly, guidelines recommend an LVEF measure for patients with suspected heart failure. Prior work has demonstrated that patients with high BNP values do not always have a measure of left ventricular ejection. Hypothesis: A reminder to patients with BNP and no imaging may prompt providers to order appropriate imaging potentially leading to 1) identification of unsuspected depressed ejection fraction and 2) more appropriate treatment.

Official Title
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Trial of Provider Notification for Patients With High B-type Natriuretic Peptide and no Imaging to Identify Unsuspected Heart Failure.

Conditions
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Heart Failure

Intervention / Treatment
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* Other: Clinical Reminder


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: BNP >= 200 pg/ml in last 2 months Exclusion Criteria: Measure of LVEF in the last 12 months Last measure of LVEF < 40%

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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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Usual Care<br>Usual care | |
| Experimental: Clinical Reminder<br>A note is sent to the primary care provider using the electronic medical record indicating the high BNP result and potential benefit of measurement of the left ventricular ejection fraction. A draft order is placed for an echocardiogram for the provider to accept or delete. | Other: Clinical Reminder<br>* A note is sent to the primary care provider using the electronic medical record indicating the high BNP result and potential benefit of measurement of the left ventricular ejection fraction. A draft order is placed for an echocardiogram for the provider to accept or delete.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Measurement of left ventricular ejection fraction | numerator: Measurement of left ventricular ejection fraction within 6 months of randomization. denominator: All randomized patients | 6 months after randomization | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Identification of LVEF < 40% | Numerator: number of patients identified with an LVEF< 40% Denominator: all randomized patients | 6 months following randomizaiton | 
| Treatment of Low LVEF | Numerator: number of patients with an LVEF < 40% and treatment with either an angiotensin converting enzyme inhibitor, angiotensin receptor blocker or evidence based beta-blocker (carvedilol, metoprolol succinate, bisoprolol). Denominator: all randomized patients. | 6 months following randomization | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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B type natriuretic peptide, heart failure, cardiac imaging, quality of care