Evidence map›Paper›PMID 38043045›Full record

ArticleJACC. Heart failure2024

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

Amrita Mukhopadhyay, Harmony R Reynolds, William C King, Lawrence M Phillips, Arielle R Nagler, Adam Szerencsy, Archana Saxena, Nathan Klapheke, Stuart D Katz, Leora I Horwitz and 1 more

Registry-linked trialOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JACC. Heart failure, 2024. 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 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.7field-weighted citation impact, top 26% 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

1 citing paper in PubMed, 3 citations in OpenAlex.

  1. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 2 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: amrita.mukhopadhyay@nyulangone.org.
Harmony R ReynoldsLeon H. Charney Division of Cardiology, Department of Medicine, 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.
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 NaglerThe Ronald O. Perelman Department of Dermatology, 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; Division of Hospital Medicine, 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.
Nathan KlaphekeMedical Center Information Technology, New York University Langone Health, 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.
Leora I HorwitzDepartment of Population Health, New York University Grossman School of Medicine, New York, New York, USA; Division of Hospital Medicine, 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; Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
New York University · USNYU Langone Health · 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

backgroundElectronic health record (EHR) tools can improve prescribing of guideline-recommended therapies for heart failure with reduced ejection fraction (HFrEF), but their effectiveness may vary by physician workload.

objectivesThis paper aims to assess whether physician workload modifies the effectiveness of EHR tools for HFrEF.

methodsThis was a prespecified subgroup analysis of the BETTER CARE-HF (Building Electronic Tools to Enhance and Reinforce Cardiovascular Recommendations for Heart Failure) cluster-randomized trial, which compared effectiveness of an alert vs message vs usual care on prescribing of mineralocorticoid antagonists (MRAs). The trial included adults with HFrEF seen in cardiology offices who were eligible for and not prescribed MRAs. Visit volume was defined at the cardiologist-level as number of visits per 6-month study period (high = upper tertile vs non-high = remaining). Analysis at the patient-level used likelihood ratio test for interaction with log-binomial models.

resultsAmong 2,211 patients seen by 174 cardiologists, 932 (42.2%) were seen by high-volume cardiologists (median: 1,853; Q1-Q3: 1,637-2,225 visits/6 mo; and median: 10; Q1-Q3: 9-12 visits/half-day). MRA was prescribed to 5.5% in the high-volume vs 14.8% in the non-high-volume groups in the usual care arm, 10.3% vs 19.6% in the message arm, and 31.2% vs 28.2% in the alert arm, respectively. Visit volume modified treatment effect (P for interaction = 0.02) such that the alert was more effective in the high-volume group (relative risk: 5.16; 95% CI: 2.57-10.4) than the non-high-volume group (relative risk: 1.93; 95% CI: 1.29-2.90).

conclusionsAn EHR-embedded alert increased prescribing by >5-fold among patients seen by high-volume cardiologists. Our findings support use of EHR alerts, especially in busy practice settings. (Building Electronic Tools to Enhance and Reinforce Cardiovascular Recommendations for Heart Failure [BETTER CARE-HF]; NCT05275920).

Indexed as

Heart FailureVentricular Dysfunction, LeftAdultHeartHumansMineralocorticoid Receptor AntagonistsStroke VolumeMineralocorticoid Receptor Antagonistsalertsclinical decision supportelectronic health recordheart failurephysician workloadvisit volume

Identifiers

PMID38043045
PMCPMC12290891
OpenAlexW4388689207

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

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.