Evidence map›Paper›PMID 42441295›Full record

ArticleEuropean heart journal. Digital health2026

Generating evidence using electronic alerts during routine care: a fully automated randomized controlled trial of oral fluid restriction in acute heart failure (THIRST alert trial).

Yang Chen, Daniel Higgins, Yogini Jani, Nausheen Saleem, Kris Chafer, Ewan McFarlane, Timothy Roberts, Steve Harris, Bryan Williams, Matthew R Sydes and 3 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in European heart journal. Digital health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05869656 (THIRST Alert Trial - a Randomised Controlled Trial Within the Electronic Health Record of an Interruptive Alert Displaying a Fluid Restriction Suggestion in Patients With the Treatable Trait of Congestion), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing 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.

NCT05869656 nacompletednot on this map

THIRST Alert Trial - a Randomised Controlled Trial Within the Electronic Health Record of an Interruptive Alert Displaying a Fluid Restriction Suggestion in Patients With the Treatable Trait of Congestion

TypeinterventionalSponsorUniversity College, LondonRan2023 to 2023Enrolled23ConditionsFluid Overload, Congestive Heart FailureArmsFluid restriction, Free fluids
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

13 authors.

Yang ChenInstitute of Health Informatics, Faculty of Population Health Sciences, University College London, Gower Street, London WC1E 6BT, UK.ORCID https://orcid.org/0000-0001-6032-3387
Daniel HigginsCentre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK.
Yogini JaniCentre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK.
Nausheen SaleemCentre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK.
Kris ChaferNational Institute for Health and Care Research, University College London Hospitals Biomedical Research Centre, 250 Euston Road, London NW1 2PG, UK.ORCID https://orcid.org/0009-0001-9427-1770
Ewan McFarlaneNational Institute for Health and Care Research, University College London Hospitals Biomedical Research Centre, 250 Euston Road, London NW1 2PG, UK.
Timothy RobertsNational Institute for Health and Care Research, University College London Hospitals Biomedical Research Centre, 250 Euston Road, London NW1 2PG, UK.
Steve HarrisInstitute of Health Informatics, Faculty of Population Health Sciences, University College London, Gower Street, London WC1E 6BT, UK.ORCID https://orcid.org/0000-0002-4982-1374
Bryan WilliamsNational Institute for Health and Care Research, University College London Hospitals Biomedical Research Centre, 250 Euston Road, London NW1 2PG, UK.
Matthew R SydesInnovative Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, Gower Street, London WC1E 6BT, UK.
Folkert W AsselbergsInstitute of Health Informatics, Faculty of Population Health Sciences, University College London, Gower Street, London WC1E 6BT, UK.
Anoop D ShahInstitute of Health Informatics, Faculty of Population Health Sciences, University College London, Gower Street, London WC1E 6BT, UK.
R Thomas LumbersInstitute of Health Informatics, Faculty of Population Health Sciences, University College London, Gower Street, London WC1E 6BT, UK.ORCID https://orcid.org/0000-0002-9077-4741

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Aims: Many medical treatments lack robust evidence of safety and effectiveness from randomized controlled trials (RCTs). This is partly due to the cost and complexity of performing traditional RCTs and because randomization is not routinely embedded in clinical care. We aimed to evaluate the feasibility of conducting a pragmatic RCT fully integrated into the electronic health record (EHR) system to streamline patient identification, randomization, treatment allocation, and outcome assessment in patients admitted with acute heart failure. Methods and results: THIRST Alert was a single-centre parallel-group, open-label, feasibility RCT embedded in a hospital EHR system from May 3 to 1 November 2023. Adult patients who received more than one dose of intravenous furosemide within 48 h of admission were eligible. An interruptive alert was triggered when physicians accessed the medication order chart of eligible patients, inviting them to enrol the patient in the study. Enrolled patients were randomized to either 'oral fluid restriction of 1 L per day' or 'no fluid restriction'. The co-primary feasibility outcomes were the total number of patients recruited and the documented difference in oral fluid intake within 48 h of randomization. Twenty-three patients (16%) were enrolled from 145 eligible patient admissions; there were no repeat admissions among enrolled patients. A total of 1191 enrolment alerts were triggered, reaching 216 individual clinicians. 22/23 trial participants (96%) had a diagnosis of heart failure. No significant difference in oral fluid intake was observed between the treatment groups (median difference 518 mL; 95% confidence interval: -235 to 1270; Conclusion: This study demonstrates the feasibility of a pragmatic RCT fully integrated within a hospital EHR system in acute care. Although alert-to-enrolment rate was modest, the overall recruitment rate was comparable to conventional acute care RCTs, highlighting the potential of EHR-embedded trials to efficiently address evidence gaps in the management of conditions such as acute heart failure. ClinicalTrialsgov: NCT05869656.

Indexed as

Clinical decision support systemElectronic health recordFluid restrictionHeart failurePoint-of-care randomizationPragmatic trials

Identifiers

PMID42441295
PMCPMC13335805

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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.