SHM Converge Scientific Abstract ePoster Gallery-Smart Heart: Assessing the Impact of an Electronic Health Record Intervention on Guideline-Directed Medical Therapy Prescribing in Heart Failure

Smart Heart: Assessing the Impact of an Electronic Health Record Intervention on Guideline-Directed Medical Therapy Prescribing in Heart Failure

Back to course

Pdf Summary

This study evaluated whether an electronic health record (EHR)-based clinical decision support system (CDSS) could improve guideline-directed medical therapy (GDMT) prescribing for patients hospitalized with heart failure. Heart failure affects nearly 7 million U.S. patients, and despite strong evidence supporting the four GDMT “pillars” (renin-angiotensin system inhibitors, β-blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors), prescribing remains inconsistent.<br /><br />Researchers analyzed all patients discharged with a primary heart failure diagnosis from 11 hospitals using Epic EHR between July 2023 and June 2025. They compared two seasonal pre-intervention periods with two post-intervention periods to account for broader quality-improvement efforts already underway. The CDSS, launched in November 2024, included an admission order set, daily order set, and heart-failure-specific note designed to prompt and guide clinicians in prescribing GDMT at discharge.<br /><br />A total of 3,535 patients were included. The average number of GDMT medications per patient increased significantly after the intervention-related periods compared with the matched pre-periods: 2.41 vs 2.24 in Post 1 vs Pre 1, and 2.49 vs 2.32 in Post 2 vs Pre 2. The proportion of patients discharged on all four GDMT pillars also improved significantly, rising from 12.92% to 19.97% in Post 1 and from 17.70% to 22.81% in Post 2. However, the difference between Post 2 and Post 1 was not statistically significant, and difference-in-difference testing did not show a clear incremental effect attributable solely to the CDSS.<br /><br />Hospitals with higher order set adherence showed larger gains in four-pillar prescribing than low-adherence hospitals, suggesting that engagement with the EHR tool may be key to impact. Overall, the authors conclude that combining incentives, workgroups, and EHR-based CDSS can improve GDMT prescribing, and that future interventions should focus on increasing order set use.

Asset Subtitle

Alan Kubey

Meta Tag

Author List Alan Kubey, Shriya Baweja

Category Research

Concept Guideline-Directed Medical Therapy

Concept Heart Failure

Concept Clinical Decision Support

Concept Four Pillars of Therapy

Concept Electronic Health Record

Distinguished Non-Finalist

Presenter Organization Thomas Jefferson University and Mayo Clinic

Presenting Author Alan Kubey

Track Quality Improvement

Keywords

heart failure

electronic health record

clinical decision support system

guideline-directed medical therapy

GDMT

hospital discharge

order set adherence

SGLT2 inhibitors

beta-blockers

quality improvement

Guideline-Directed Medical Therapy

Heart Failure

Clinical Decision Support

Four Pillars of Therapy

Electronic Health Record