Impact of Visit Volume on the Effectiveness of Electronic Tools to Improve Heart Failure Care

Mukhopadhyay, A; Reynolds, HR; King, WC; Phillips, LM; Nagler, AR; Szerencsy, A; Saxena, A; Klapheke, N; Katz, SD; Horwitz, LI; Blecker, S

doi:10.1016/j.jchf.2023.11.002

Heart failure & cardiomyopathies

Impact of Visit Volume on the Effectiveness of Electronic Tools to Improve Heart Failure Care

JACC Heart FailPublished 15 Nov 2023Secondary analysis of the BETTER CARE-HF randomised trial

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Authors' conclusion

An EHR-embedded alert increased prescribing by >5-fold among patients seen by high-volume cardiologists.

Study context

Population: Adults with heart failure with reduced ejection fraction (HFrEF) seen in cardiology offices, eligible for and not prescribed mineralocorticoid antagonists (MRAs)174 cardiologists
Participants: 2,211 adults

Comparison: Electronic health record (EHR) alert vs message vs usual care, by cardiologist visit volume
Primary endpoint: MRA prescribing; effect modification by cardiologist visit volume (high = upper tertile vs non-high)

Methodological detailsprespecified subgroup analysis, cluster-randomized

Prespecified subgroup analysis
Cluster-randomized

Primary result

As reported in the abstract

MRA prescribed, by visit volume

Usual care, high-volume5.5%

Usual care, non-high-volume14.8%

Message, high-volume10.3%

Message, non-high-volume19.6%

Alert, high-volume31.2%

Alert, non-high-volume28.2%

Alert vs Usual careRelative risk (95% CI)P value

High-volume

5.16(2.57–10.4)

P = 0.02for interaction

Non-high-volume

1.93(1.29–2.90)

P = 0.02for interaction

Original publication

Impact of Visit Volume on the Effectiveness of Electronic Tools to Improve Heart Failure Care. JACC Heart Fail. Published 15 November 2023. doi:10.1016/j.jchf.2023.11.002

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