Highlights
- •Many heart failure (HF) patients who could benefit from advanced therapies are not referred as soon as they should be.
- •We developed a computer application with sufficient data access and a high enough level of clinical decision support logic that promotes timely and appropriate referral for advanced HF therapies.
- •Intervention patients were referred to specialized heart facilities significantly more often within 30 days (57% vs 34%; P < .001), 60 days (69% vs 44%; P < .0001), 90 days (73% vs 49%; P < .0001), and 180 days (79% vs 58%; P < .0001) than control patients.
- •Significantly more intervention patients were found to be alive at 30 days (95% vs 92%; P = .036) at 60 days (95% vs 90%; P = .0013), 90 days (94% vs 87%; P = .0002), and 180 days (92% vs 84%; P = .0001) than control patients.
Abstract
Background
Patients who need and receive timely advanced heart failure (HF) therapies have better
long-term survival. However, many of these patients are not identified and referred
as soon as they should be.
Methods
A clinical decision support (CDS) application sent secure email notifications to HF
patients' providers when they transitioned to advanced disease. Patients identified
with CDS in 2015 were compared with control patients from 2013 to 2014. Kaplan-Meier
methods and Cox regression were used in this intention-to-treat analysis to compare
differences between visits to specialized and survival.
Results
Intervention patients were referred to specialized heart facilities significantly
more often within 30 days (57% vs 34%; P < .001), 60 days (69% vs 44%; P < .0001), 90 days (73% vs 49%; P < .0001), and 180 days (79% vs 58%; P < .0001). Age and sex did not predict heart facility visits, but renal disease did
and patients of nonwhite race were less likely to visit specialized heart facilities.
Significantly more intervention patients were found to be alive at 30 (95% vs 92%;
P = .036), 60 (95% vs 90%; P = .0013), 90 (94% vs 87%; P = .0002), and 180 days (92% vs 84%; P = .0001). Age, sex, and some comorbid diseases were also predictors of mortality,
but race was not.
Conclusions
We found that CDS can facilitate the early identification of patients needing advanced
HF therapy and that its use was associated with significantly more patients visiting
specialized heart facilities and longer survival.
Key Words
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Article info
Publication history
Published online: August 15, 2017
Accepted:
August 10,
2017
Received in revised form:
August 9,
2017
Received:
February 20,
2017
Footnotes
Funding: This work was a quality improvement project sponsored by the IH Cardiovascular Clinical Program and funded by IH.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
