Can Electronic Decision Support Improve Acute Heart Failure Care in EDs?

METHODOLOGY:

• The researchers conducted a pilot study involving 234 patients with AHF discharged from two large urban EDs in Northern California from January 2023 to July 2023 to assess the feasibility and safety of a passive electronic alert system.
• The study utilized a two-tiered clinical decision support system: an 'AHF Banner' to nudge providers and an opt-in 'AHF report' offering tailored medical recommendations and personalized 30-day risk estimates using the STRIDE-HF risk tool for SAEs.
• The researchers assessed active prescriptions for beta-blockers (BBs), renin-angiotensin receptor system inhibitors (RASis), sodium-glucose transport protein 2 inhibitors (SGLT2is), and mineralocorticoid receptor antagonists (MRAs) at ED arrival, as well as the initiation of new classes within 72 hours of discharge.
• Prior to the launch of the decision support tool, ED clinicians received two 30-minute education sessions on AHF care and incorporating the tool into standard workflows.

TAKEAWAY:

• Overall, 21.8% had HF with reduced ejection fraction (HFrEF), 9.0% had HF with mildly reduced ejection fraction (HFmrEF), and 53.8% had HF with preserved ejection fraction (HFpEF).
• At ED arrival, 68.6%, 66.7%, 25.5%, and 19.6% patients with HFrEF were on a RASi, a BB, an SGLT2i, and an MRA, respectively. In contrast, 42.9%, 66.7%, 14.3%, and 4.8% patients with HFmrEF were on a RASi, a BB, an SGLT2i, and an MRA, respectively. An SGLT2i was the most prescribed new medication at ED discharge, with nearly a 10% increase in the proportion of patients with an active prescription.
• Among the 126 patients with HFpEF, only 4.8% were on an SGLT2i at ED arrival, and no new prescriptions for this medication class were issued at discharge.
• The researchers found no 30-day SAEs, including death, cardiopulmonary resuscitation, balloon-pump insertion, intubation, initiation of dialysis, myocardial infarction, or coronary revascularization, among the 51 patients discharged with a very low predicted risk for HF.