Evidence map›Paper›PMID 36882134›Full record

Trial reportJournal of the American College of Cardiology2023

Cluster-Randomized Trial Comparing Ambulatory Decision Support Tools to Improve Heart Failure Care.

Amrita Mukhopadhyay, Harmony R Reynolds, Lawrence M Phillips, Arielle R Nagler, William C King, Adam Szerencsy, Archana Saxena, Rod Aminian, Nathan Klapheke, Leora I Horwitz and 2 more

Registry-linked trialOpen access · greenAbstract readRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of the American College of Cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05275920 (Building Electronic Tools To Enhance and Reinforce CArdiovascular REcommendations - Heart Failure), which is not on this map. Cited by 28 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 1 pooled it
14.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05275920 nacompletednot on this map

Building Electronic Tools To Enhance and Reinforce CArdiovascular REcommendations - Heart Failure (BETTER CARE-HF)

TypeinterventionalSponsorNYU Langone HealthRan2022 to 2022Enrolled2,211ConditionsHeart Failure, Heart Failure With Reduced Ejection FractionArmsBest Practice Alert (BPA), In-Basket Message
3 · Its place in the literature

Who cites it

28 citing papers in PubMed, 1 synthesis or guideline pooled it, 66 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 3 institutions in 1 country.

Amrita MukhopadhyayLeon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA. Electronic address: https://twitter.com/AmritaMukhopaMD.
Harmony R ReynoldsLeon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
Lawrence M PhillipsLeon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
Arielle R NaglerRonald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York, USA.
William C KingDepartment of Population Health, New York University Grossman School of Medicine, New York, New York, USA.
Adam SzerencsyMedical Center Information Technology, New York University Langone Health, New York, New York, USA; Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
Archana SaxenaLeon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA; Medical Center Information Technology, New York University Langone Health, New York, New York, USA.
Rod AminianMedical Center Information Technology, New York University Langone Health, New York, New York, USA.
Nathan KlaphekeMedical Center Information Technology, New York University Langone Health, New York, New York, USA.
Leora I HorwitzDepartment of Population Health, New York University Grossman School of Medicine, New York, New York, USA; Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
Stuart D KatzLeon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
Saul BleckerDepartment of Population Health, New York University Grossman School of Medicine, New York, New York, USA; Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
New York University · USNYU Langone Health · USTwitter (United States) · US

Funding

Project-005UL1TR001445 · NCATS · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · PI BREDELLA, MIRIAM ANTOINETTE, HOCHMAN, JUDITH S · 2015 to 2025
$103.5M
Training Program in Cardiovascular SciencesT32HL098129 · NHLBI · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · PI Glenn I Fishman, Ira J Goldberg · 2009 to 2026
$5.9M
NCATS NIH HHS UL1 TR001445NHLBI NIH HHS T32 HL098129
6 · The paper itself

Abstract

backgroundMineralocorticoid receptor antagonists (MRAs) are underprescribed for patients with heart failure with reduced ejection fraction (HFrEF).

objectivesThis study sought to compare effectiveness of 2 automated, electronic health record-embedded tools vs usual care on MRA prescribing in eligible patients with HFrEF.

methodsBETTER CARE-HF (Building Electronic Tools to Enhance and Reinforce Cardiovascular Recommendations for Heart Failure) was a 3-arm, pragmatic, cluster-randomized trial comparing the effectiveness of an alert during individual patient encounters vs a message about multiple patients between encounters vs usual care on MRA prescribing. This study included adult patients with HFrEF, no active MRA prescription, no contraindication to MRAs, and an outpatient cardiologist in a large health system. Patients were cluster-randomized by cardiologist (60 per arm).

resultsThe study included 2,211 patients (alert: 755, message: 812, usual care [control]: 644), with average age 72.2 years, average ejection fraction 33%, who were predominantly male (71.4%) and White (68.9%). New MRA prescribing occurred in 29.6% of patients in the alert arm, 15.6% in the message arm, and 11.7% in the control arm. The alert more than doubled MRA prescribing compared to usual care (relative risk: 2.53; 95% CI: 1.77-3.62; P < 0.0001) and improved MRA prescribing compared to the message (relative risk: 1.67; 95% CI: 1.21-2.29; P = 0.002). The number of patients with alert needed to result in an additional MRA prescription was 5.6.

conclusionsAn automated, patient-specific, electronic health record-embedded alert increased MRA prescribing compared to both a message and usual care. These findings highlight the potential for electronic health record-embedded tools to substantially increase prescription of life-saving therapies for HFrEF. (Building Electronic Tools to Enhance and Reinforce Cardiovascular Recommendations-Heart Failure [BETTER CARE-HF]; NCT05275920).

Indexed as

Heart FailureAdultAgedFemaleHeartHumansMaleMineralocorticoid Receptor AntagonistsOutpatientsStroke VolumeMineralocorticoid Receptor Antagonistsalertclinical decision supportelectronic health recordheart failuremessagemineralocorticoid receptor antagonist

Identifiers

PMID36882134
PMCPMC10807493
OpenAlexW4323268837

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.