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A majority of patients with heart failure (HF) do not receive adequate medical therapy as recommended by clinical guidelines. One major obstacle encountered by population health management (PHM) programs to improve medication usage is the substantial burden placed on clinical staff who must manually sift through electronic health records (EHRs) to ascertain patients' eligibility for the guidelines. As a potential solution, the study team developed a rule-based system (RBS) that automatically parses the EHR for identifying patients with HF who may be eligible for guideline-directed therapy. The RBS was deployed to streamline a PHM program at Brigham and Women's Hospital wherein the RBS was executed every other month to identify potentially eligible patients for further screening by the program staff. The study team evaluated the performance of the system and performed an error analysis to identify areas for improving the system. Of approximately 161,000 patients who have an echocardiogram in the health system, each execution of the RBS typically identified around 4200 patients. A total 5460 patients were manually screened, of which 1754 were found to be truly eligible with an accuracy of 32.1%. An analysis of the false-positive cases showed that over 38% of the false positives were due to incorrect determination of symptomatic HF and medication history of the patients. The system's performance can be potentially improved by integrating information from clinical notes. The RBS provided a systematic way to narrow down the patient population to a subset that is enriched for eligible patients. However, there is a need to further optimize the system by integrating processing of clinical notes. This study highlights the practical challenges of implementing automated tools to facilitate guideline-directed care. [ABSTRACT FROM AUTHOR]

Background: Although strategies for optimization of pharmacologic therapy in patients with heart failure with reduced ejection fraction (HFrEF) are scripted by guidelines, data from HF registries suggests that guideline-directed medical therapies (GDMT) are underutilized among eligible patients. Whether this discrepancy reflects medication intolerance, contraindications, or a quality of care issue remains unclear. Objective: The objective of this initiative was to identify reasons for underutilization and under-dosing of HFrEF therapy in patients at a large, academic medical center. Methods: Among 500 patients with HFrEF enrolled in a quality improvement project at a tertiary center, we evaluated usage and dosing of 4 categories of GDMT: ACE inhibitors/Angiotensin Receptor Blockers (ACE-i/ARB), Angiotensin Receptor-Neprilysin Inhibitors (ARNi), beta blockers, and Mineralocorticoid Receptor Antagonists (MRA). Reasons for nonprescription and usage of suboptimal doses were abstracted from notes in the chart and from telephone review of previous medication trials with the patient. Results: Of 500 patients identified, 472 subjects had complete data for analysis. Among eligible patients, ACE-i/ARB were prescribed in 81.4% (293 of 360) and beta blockers in 94.4% (442 of 468). Of these patients, 10.6% were prescribed target doses of ACE-i/ARB and 12.4% were prescribed target doses of beta blockers. Utilization of other categories of GDMT was lower, with 54% of eligible patients prescribed MRAs and 27% prescribed an ARNi. In most cases, the reasons for nonprescription or under-dosing of GDMT were not apparent on review of the health record or discussion with the patient. Conclusion: Clear rationale for nonprescription and under-dosing of GDMT often cannot be ascertained from detailed review and is only rarely related to documented medication intolerance or contraindications, suggesting an opportunity for quality improvement. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to describe the prevalence of obesity, obesity-related conditions (ORCs), and antiobesity medication (AOM) eligibility and prescribing practice among eligible patients in a large health care system., Methods: In this cross-sectional analysis of the multicenter Mass General Brigham health care system (Boston, Massachusetts) spanning 2018 to 2022, adults eligible for AOMs (BMI ≥ 30 kg/m 2 or BMI 27-29.9 kg/m 2 with ≥1 ORC) were identified. Among those AOM-eligible, the prevalence of prescriptions for AOMs approved for long-term weight management was evaluated., Results: Of 2,469,474 adults (mean [SD], age 53 [19] years; 57% female; BMI 28.1 [6.3] kg/m 2 ), a total of 1,110,251 (45.0%) were eligible for AOMs. Of these, 69.4% (31.2% of overall cohort) had BMI ≥ 30 kg/m 2 . AOM prescription was observed in 15,214 (1.4%) of all eligible patients, with female sex, younger age, higher BMI, commercial insurance, and greater ORC burden associated with higher prevalence of AOM prescriptions. Musculoskeletal disorders (54%) were the most common ORCs, with ≥2 ORCs observed in 62% of patients. Liraglutide 3.0 mg and semaglutide 2.4 mg were the most frequently prescribed AOMs (58% and 34% of all AOMs, respectively)., Conclusions: Although nearly one-half of all patients in a large health care system were AOM-eligible by guidelines and regulatory labeling, only 1% of those who were eligible were prescribed AOMs., (© 2024 The Author(s). Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.)

Background: Remote hypertension management programs have emerged as potential solutions to improve poor rates of blood pressure (BP) control. The Continual Versus Occasional Blood Pressure (COOL-BP) Study investigated the feasibility and efficacy of using a cuffless wrist BP monitor in a remote hypertension (HTN) program., Methods: COOL-BP was a prospective single-arm study within a larger HTN management program at Mass General Brigham (MGB). Participants had uncontrolled HTN, were already engaged in the MGB Remote Hypertension Program, and used a smartphone. The study involved patients wearing the Aktiia cuffless wrist BP monitor and performing traditional home BP monitoring (HBPM). The primary endpoint was the correlation of BP measurements between devices. Secondary endpoints included concordance between HBPM and cuffless pressures following a medication titration, and patient satisfaction with the cuffless device., Results: We enrolled 38 patients, of whom 25 provided BP data on overlapping dates with both devices. There was moderate correlation between average non-simultaneous daytime BPs within the same time periods (r=0.57, 95% CI: 0.39-0.71 for systolic BP [p<0.001]; r=0.64, 95% CI: 0.48-0.76, for diastolic BP [p<0.001]). The concordance of systolic BP changes detected by the two devices post-medication titration was 87.5%. Most patients (91%) preferred the cuffless device, citing ease of use and convenience., Conclusion: Cuffless BP devices demonstrate promise in enhancing patient compliance and effectiveness in HTN management. Their integration into clinical practice could offer a more patient-friendly and reliable approach to BP monitoring, though more research is needed to establish their utility in large populations., (© The Author(s) 2025. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd.)

Background: The prevalence, chronicity and clinical impact of type 2 diabetes (T2D) defines this disease state as a critical determinant in morbidity and mortality, as encountered by individuals, health care systems, and public health in general. The need to understand and optimize T2D identification and management is now further heightened by the advent of medications with established cardiovascular (CV) and kidney benefits in such patients, namely sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA). Prescription rates for these agents have remained low despite guidelines incorporating and emphasizing their use. Better understanding T2D disease and management patterns, including percentage of patients meeting guideline indications, is necessary to address undertreatment, improve patient management, and enable better strategies. We evaluated such issues, including eligibility for and utilization of SGLT2i and GLP-1 RA, in a large health system caring for over 1.5 million patients annually., Methods: The electronic health record (EHR) at a large health network in the Northeastern United States was queried to identify patients 18 yrs of age or older with T2D and at least 1 hemoglobin A1c (HbA1c) between 1/1/2020 and 1/1/2023, examining those with T2D and 1) atherosclerotic CV disease (ASCVD), 2) an estimated 10-year ASCVD risk score ≥10% without known ASCVD, 3) heart failure (HF), and/or 4) chronic kidney disease (CKD) based on EHR listed comorbidities. Demographics, medications, comorbidities, and indications for SGLT2i and/or GLP-1 RA therapy were assessed by one or more of the 4 indications above as outlined in society guidelines., Results: Of the 147,338 patients who met inclusion criteria, 47% were female, 28% were non-white, and 14% with a non-English language preference. Of those, 121,508 (83%) had an indication for either SGLT2i or GLP-1 RA based on guideline recommendations: 17% were prescribed an SGLT2i, 22% were prescribed GLP-1 RA, and 6% of patients were prescribed both medications, with only 32% of those eligible prescribed therapy. Of patients eligible for either an SGLT2i or GLP-1 RA therapy not currently receiving either therapy, 49% had 10-year ASCVD risk ≥10% without known ASCVD, 42% had ASCVD, 52% had CKD, and 14% had HF., Conclusion: More than four out of five patients with T2D had a CV or kidney indication for either SGLT2i or GLP-1 RA. However, uptake of SGLT2i/GLP-1 RA in these high-risk populations remains low (just 32%) across this health network. Future studies are needed to identify better strategies to overcome provider, patient, and system-level barriers to the uptake and dissemination of guideline-concordant T2D therapies., (Copyright © 2025. Published by Elsevier Inc.)

The wide gap between a care provider's conceptualization of electronic health record (EHR) and the structures for electronic health record (EHR) data storage and transmission, presents a multitude of obstacles for development of innovative Health IT applications. While developers model the EHR view of the clinicians at one end, they work with a different data view to construct health IT applications. Although there has been considerable progress to bridge this gap by evolution of developer friendly standards and tools for terminology mapping and data warehousing, there is a need for a simplified framework to facilitate development of interoperable applications. To this end, we propose a framework for creating a layer of semantic abstraction on the EHR and describe preliminary work on the implementation of this framework for management of hyperlipidemia and hypertension. Our goal is to facilitate the rapid development and portability of Health IT applications.