Evidence map›Paper›PMID 39054726›Full record

ArticleESC heart failure2024

Pilot trial of an electronic decision support to improve care for emergency department patients with acute heart failure.

Dana R Sax, Dustin G Mark, Jamal S Rana, Jie Huang, Scott D Casey, Robert P Norris, Viliami Tillage, Mary E Reed

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in ESC heart failure, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Dana R SaxThe Permanente Medical Group, Oakland, California, USA.ORCID 0000-0002-9061-7746
Dustin G MarkThe Permanente Medical Group, Oakland, California, USA.
Jamal S RanaThe Permanente Medical Group, Oakland, California, USA.
Jie HuangKaiser Permanente Northern California Division of Research, Pleasanton, California, USA.
Scott D CaseyKaiser Permanente Northern California Division of Research, Pleasanton, California, USA.
Robert P NorrisThe Permanente Medical Group, Sacramento, California, USA.
Viliami TillageDrexel University School of Medicine, Philadelphia, Pennsylvania, USA.
Mary E ReedKaiser Permanente Northern California Division of Research, Pleasanton, California, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsEmergency department (ED) providers play an important role in the management of patients with acute heart failure (AHF). We present findings from a pilot study of an electronic decision support that includes personalized risk estimates using the STRIDE-HF risk tool and tailored recommendations for initiating guideline directed medical therapy (GDMT) among appropriate patients.

methodsAmong ED patients treated for AHF who were discharged from the ED or the ED-based observation unit in two EDs from 1 January 2023 to 31 July 2023, we assess prescriptions to the four classes of GDMT at two intervals: (1) ED arrival and (2) ED discharge. Specifically, we report active prescriptions for beta-blockers (BBs), renin-angiotensin receptor system inhibitors (RASis), sodium-glucose transport protein 2 inhibitors (SGLT2is) and mineralocorticoid receptor antagonists (MRA) among patients with reduced ejection fraction (HFrEF) and mildly reduced (HFmrEF). Second, we describe rates of 30-day serious adverse events (SAE) (death, cardiopulmonary resuscitation, balloon-pump insertion, intubation, new dialysis, myocardial infarction or coronary revascularization) among patients predicted to be very low risk by STRIDE-HF and discharged home.

resultsAmong 234 discharged patients, 55% were female and 76% were non-White. We found 51 (21.8%), 21 (9.0%) and 126 (53.8%) had HFrEF, HFmEF and HFpEF, respectively, while 36 (15.4%) were missing EF, and 51 (22%) were very low risk, 82 (35%) were low risk, 60 (26%) were medium risk and 41 (18%) were high risk. Among HFrEF patients, 68.6%, 66.7%, 25.5% and 19.6% were on a RASi, BB, SGLT2i and MRA, respectively, at ED arrival, while 42.9%, 66.7%, 14.3% and 4.8% of HFmrEF patients were on a RASi, BB, SGLT2i and MRA, respectively. Among patients with HFpEF, only 6 (4.8%) were on an SGLT2i at ED arrival. The most prescribed new medication at ED discharge was an SGLT2i, with a nearly 10% increase in the proportion of patients with an active prescription for SGLT2i at ED discharge among HFrEF and HFmEF patients. We observed no 30-day SAE among the 51 patients predicted to be very low risk and discharged home.

conclusionsOngoing treatment with GDMT at ED arrival was sub-optimal. Initiation among appropriate patients at discharge may be feasible and safe.

Indexed as

Emergency Service, HospitalHeart FailureAcute DiseaseAgedDecision Support Systems, ClinicalFemaleHumansMaleMiddle AgedPilot ProjectsQuality ImprovementRetrospective StudiesRisk AssessmentAcute heart failureElectronic clinical decision supportEmergency departmentGuideline directed medical therapyRisk stratification

Identifiers

PMID39054726
PMCPMC11631321

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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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.