Implementation of a Heart Failure Trajectory Smart Phrase in the EMR Increases Rates of Guideline Directed Medical Therapy at Discharge

Joshua Remick; Renee Ceres Swanson; Adam Mizgajski; Kellie L. Graybosch; Hsin-Fang Li; Kateri Spinelli; Margaret Richter

doi:10.1016/S0735-1097(24)02477-X

Implementation of a Heart Failure Trajectory Smart Phrase in the EMR Increases Rates of Guideline Directed Medical Therapy at Discharge

Joshua Remick, Renee Ceres Swanson, Adam Mizgajski, Kellie L. Graybosch, Hsin-Fang Li, Kateri Spinelli, Margaret Richter

Research output: Other contribution

Abstract

Background

Our goal was to operationalize the 2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of the Hospitalized Heart Failure (HF) Patient.

Methods

In March 2022, we implemented an EMR smartphrase identifying HF patient's daily trajectory (improving, stalled, or worsening) and documenting appropriate interventions and escalation of care. The smartphrase captured clinical data; coupled with patient assessment, providers were prompted to address diuretic management, guideline directed medical therapy (GDMT), and consultations. Extensive training on the ACC pathway, smartphrase, GMDT, and standard trajectory language was delivered to cardiology and hospitalist providers and cardiology nursing staff. Data on smartphrase utilization and outcomes was collected at 5-month intervals.

Results

The trajectory smartphrase project showed the most significant effect on prescribing patterns of GDMT. Although the prescriptions for beta-blockers and ACEi/ARB/ARNi were not significantly different (≤ 6%) whether the smart phrase was used or not, mineralocorticoids (MRA) and sodium glucose cotransporter 2 inhibitors (SGLT2i) prescribing improved significantly when the smartphrase was used vs not used [SGLT2i: 78% vs 36%, p=.0042 (Aug 2022); 97% vs 46%, p Download Figure Download PowerPoint

Conclusion

Use of the HF Trajectory Smartphrase improved prescribing of GDMT in hospitalized HF patients.

Footnotes

Poster Contributions

Hall B4-5

Saturday, April 6, 2024, 1:45 p.m.-2:30 p.m.

Session Title: 1284: Heart Failure and Cardiomyopathies: Pharmacology 05

Abstract Category: 07. Heart Failure and Cardiomyopathies: Pharmacology

Presentation Number: 1284-125

Original language	Undefined/Unknown
DOIs	https://doi.org/10.1016/S0735-1097(24)02477-X
State	Published - Apr 1 2024

Publication series

Name	Articles, Abstracts, and Reports

Access to Document

10.1016/S0735-1097(24)02477-XLicense: Unspecified

http://digitalcommons.providence.org/publications/9439

Cite this

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title = "Implementation of a Heart Failure Trajectory Smart Phrase in the EMR Increases Rates of Guideline Directed Medical Therapy at Discharge",

abstract = "Background Our goal was to operationalize the 2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of the Hospitalized Heart Failure (HF) Patient. Methods In March 2022, we implemented an EMR smartphrase identifying HF patient's daily trajectory (improving, stalled, or worsening) and documenting appropriate interventions and escalation of care. The smartphrase captured clinical data; coupled with patient assessment, providers were prompted to address diuretic management, guideline directed medical therapy (GDMT), and consultations. Extensive training on the ACC pathway, smartphrase, GMDT, and standard trajectory language was delivered to cardiology and hospitalist providers and cardiology nursing staff. Data on smartphrase utilization and outcomes was collected at 5-month intervals. Results The trajectory smartphrase project showed the most significant effect on prescribing patterns of GDMT. Although the prescriptions for beta-blockers and ACEi/ARB/ARNi were not significantly different (≤ 6%) whether the smart phrase was used or not, mineralocorticoids (MRA) and sodium glucose cotransporter 2 inhibitors (SGLT2i) prescribing improved significantly when the smartphrase was used vs not used [SGLT2i: 78% vs 36%, p=.0042 (Aug 2022); 97% vs 46%, p Download FigureDownload PowerPoint Conclusion Use of the HF Trajectory Smartphrase improved prescribing of GDMT in hospitalized HF patients. Footnotes Poster Contributions Hall B4-5 Saturday, April 6, 2024, 1:45 p.m.-2:30 p.m. Session Title: 1284: Heart Failure and Cardiomyopathies: Pharmacology 05 Abstract Category: 07. Heart Failure and Cardiomyopathies: Pharmacology Presentation Number: 1284-125",

author = "Joshua Remick and Swanson, {Renee Ceres} and Adam Mizgajski and Graybosch, {Kellie L.} and Hsin-Fang Li and Kateri Spinelli and Margaret Richter",

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T1 - Implementation of a Heart Failure Trajectory Smart Phrase in the EMR Increases Rates of Guideline Directed Medical Therapy at Discharge

AU - Remick, Joshua

AU - Swanson, Renee Ceres

AU - Mizgajski, Adam

AU - Graybosch, Kellie L.

AU - Li, Hsin-Fang

AU - Spinelli, Kateri

AU - Richter, Margaret

PY - 2024/4/1

Y1 - 2024/4/1

N2 - Background Our goal was to operationalize the 2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of the Hospitalized Heart Failure (HF) Patient. Methods In March 2022, we implemented an EMR smartphrase identifying HF patient's daily trajectory (improving, stalled, or worsening) and documenting appropriate interventions and escalation of care. The smartphrase captured clinical data; coupled with patient assessment, providers were prompted to address diuretic management, guideline directed medical therapy (GDMT), and consultations. Extensive training on the ACC pathway, smartphrase, GMDT, and standard trajectory language was delivered to cardiology and hospitalist providers and cardiology nursing staff. Data on smartphrase utilization and outcomes was collected at 5-month intervals. Results The trajectory smartphrase project showed the most significant effect on prescribing patterns of GDMT. Although the prescriptions for beta-blockers and ACEi/ARB/ARNi were not significantly different (≤ 6%) whether the smart phrase was used or not, mineralocorticoids (MRA) and sodium glucose cotransporter 2 inhibitors (SGLT2i) prescribing improved significantly when the smartphrase was used vs not used [SGLT2i: 78% vs 36%, p=.0042 (Aug 2022); 97% vs 46%, p Download FigureDownload PowerPoint Conclusion Use of the HF Trajectory Smartphrase improved prescribing of GDMT in hospitalized HF patients. Footnotes Poster Contributions Hall B4-5 Saturday, April 6, 2024, 1:45 p.m.-2:30 p.m. Session Title: 1284: Heart Failure and Cardiomyopathies: Pharmacology 05 Abstract Category: 07. Heart Failure and Cardiomyopathies: Pharmacology Presentation Number: 1284-125

AB - Background Our goal was to operationalize the 2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of the Hospitalized Heart Failure (HF) Patient. Methods In March 2022, we implemented an EMR smartphrase identifying HF patient's daily trajectory (improving, stalled, or worsening) and documenting appropriate interventions and escalation of care. The smartphrase captured clinical data; coupled with patient assessment, providers were prompted to address diuretic management, guideline directed medical therapy (GDMT), and consultations. Extensive training on the ACC pathway, smartphrase, GMDT, and standard trajectory language was delivered to cardiology and hospitalist providers and cardiology nursing staff. Data on smartphrase utilization and outcomes was collected at 5-month intervals. Results The trajectory smartphrase project showed the most significant effect on prescribing patterns of GDMT. Although the prescriptions for beta-blockers and ACEi/ARB/ARNi were not significantly different (≤ 6%) whether the smart phrase was used or not, mineralocorticoids (MRA) and sodium glucose cotransporter 2 inhibitors (SGLT2i) prescribing improved significantly when the smartphrase was used vs not used [SGLT2i: 78% vs 36%, p=.0042 (Aug 2022); 97% vs 46%, p Download FigureDownload PowerPoint Conclusion Use of the HF Trajectory Smartphrase improved prescribing of GDMT in hospitalized HF patients. Footnotes Poster Contributions Hall B4-5 Saturday, April 6, 2024, 1:45 p.m.-2:30 p.m. Session Title: 1284: Heart Failure and Cardiomyopathies: Pharmacology 05 Abstract Category: 07. Heart Failure and Cardiomyopathies: Pharmacology Presentation Number: 1284-125

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