Pragmatic trial of messaging to providers about treatment of acute heart failure: The PROMPT-AHF trial.

Acute Heart failure (AHF) is among the most frequent causes of hospitalization in the United States, contributing to substantial health care costs, morbidity, and mortality. Inpatient initiation of guideline-directed medical therapy (GDMT) is recommended for patients with heart failure with reduced ejection fraction (HFrEF) to reduce the risk of cardiovascular death or HF hospitalization. However, underutilization of GDMT prior to discharge is pervasive, representing a valuable missed opportunity to optimize evidence-based care. The PRagmatic Trial Of Messaging to Providers about Treatment of Acute Heart Failure tests the effectiveness of an electronic health record embedded clinical decision support system that informs providers during hospital management about indicated but not yet prescribed GDMT for eligible AHF patients with HFrEF. PRagmatic Trial Of Messaging to Providers about Treatment of Acute Heart Failureis an open-label, multicenter, pragmatic randomized controlled trial of 1,012 patients hospitalized with HFrEF. Eligible patients randomized to the intervention group are exposed to a tailored best practice advisory embedded within the electronic health record that alerts providers to prescribe omitted GDMT. The primary outcome is an increase in the proportion of additional GDMT medication classes prescribed at the time of discharge compared to those in the usual care arm.
Competing Interests: Disclosures JH, TO, JM are employees of AstraZeneca. RJR is a consultant for Alexion, Amgen, AstraZeneca, Boehringer Ingelheim, Janssen, Johnson & Johnson, PhaseBio, and Portola. RD does executive teaching for Sanofi Consumer Health care. SEI has served on clinical trial committees and advisory boards for Boehringer Ingelheim, AstraZeneca, and Novo Nordisk. He has served as a consultant to Merck, Pfizer, Lexicon, vTv Therapeutics, Esperion and Abbott and has delivered lectures supported by Boehringer Ingelheim and AstraZeneca. TA is consultant for Sanofi-Aventis, Amgen, Cytokinetics. He has research funding from Boehringer Ingelheim, AstraZeneca, Cytokinetics, and Relypsa. NRD works under contract with the Centers for Medicare and Medicaid Services to develop and maintain performance measures used for public reporting and pay for performance programs. He reports research grants and consulting for Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cytokinetics, Novartis, SCPharmaceuticals, and Vifor. The remaining authors have nothing to disclose.
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