ArticlePloS one2025
Impact of clinical pathways on enhancing compliance with evidence-based therapies for Heart failure with reduced ejection fraction-A retrospective cohort study.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHeart failure (HF) mortality is rising despite robust evidence-based guidelines. Hospitalization presents an opportune time to optimize care. Inpatient care pathways (CP) embedded in the electronic health record (EHR) can enhance adherence to guidelines by providing real-time decision support.
objectiveTo measure the impact of the heart failure reduced ejection fraction (HFrEF) CP on early diuretic use, goal-directed medical therapy (GDMT), and referral to comprehensive HF management (CHFM) on discharge.
methodsA HFrEF CP embedded into the EHR was built by multidisciplinary providers across a large academic medical center. Providers could place orders and document notes directly from the pathway. We conducted a retrospective cohort study of all the HF hospitalizations two years after pathway implementation and further limited the cohort to those with ejection fraction (EF) ≤ 40%. We compared rates of early diuretic use, GDMT, and referral to CHFM between cohorts defined by pathway use.
results1,639 patients contributed 2,062 hospitalizations. The pathway was opened in 362 (17.6%) hospitalizations. There were no significant clinical or sociodemographic differences between groups. Bivariate analyses revealed more GDMT (χ2 (1) = 3.651, p = 0.056); while multivariable analysis showed more early diuretics (OR = 1.58, 95% CI 1.19, 2.09, p = 0.002) and referrals to CHFM (OR = 3.24, 95% CI 2.54, 4.12, p < 0.001) in the pathway group.
conclusionDespite low utilization, pathway use was associated with more early diuretics and referrals to CHFM with a trend toward more GDMT on discharge. CPs are a feasible strategy to optimize care for hospitalized HF patients.
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