The Impact of an Adaptive Patient-Centered Web Application on Medication Optimization in HFrEF Patients

Heart failure (HF) exists in millions of Americans and represents the most common hospital discharge diagnosis among older adults. Forty percent of patients with HF are readmitted within 1 year after their first HF admission, representing significant potentially avoidable healthcare costs. Reasons behind readmissions include lack of awareness that a patient is having worsening HF, lack of adherence to an appropriate diet, and failure of guidelines-based medication optimization.

The use of guideline-directed medication therapy (GDMT) reduces hospital admission and mortality for those with HF with reduced ejection fraction (HFrEF). Although the American College of Cardiology recommends the use of electronic health records (EHRs) to reduce errors, improve clinical decision support, and promote GDMT, healthcare systems lack an effective patient-centered EHR tool that incorporates clinical data from an EHR to inform recommendations for clinicians to optimize GDMT.

The researchers previously developed a web-based app called SmartHF that provides patients with tailored information about HFrEF GDMT optimization. The app uses data from the EHR—including medications, labs, allergies and intolerances, race, and vital signs—and applies it to a validated computable algorithm to provide recommendations to the patient. The app prompts the patient to share recommendations from the app with their provider via their patient portal messaging system.

The research team will apply SMART-on-FHIR standards to SmartHF, so that it can be interoperable and scalable for use with any EHR.

The specific aims of the research are as follows:

• Determine the effects of the SmartHF intervention on GDMT prescribing in HFrEF.
• Assess concordance between the recommendations provided by the medication optimization algorithm and the GDMT medications prescribed.
• Identify the patient and provider characteristics that moderate the effectiveness of SmartHF on optimizing medications in HFrEF.

The team will then evaluate the effectiveness of this SMART-on-FHIR app via a 12-week prospective randomized controlled multicenter clinical trial. Patients over age 18 with HFrEF will be randomized to the use of SmartHF versus standard medication education. Patients with end-stage HF, actively treated cancer, implanted ventricular assist device, current treatment with chronic inotropic therapy, or being cared for by an advanced HF specialist, will be excluded from the trial. The researchers hypothesize that, over the 12 weeks, those using SmartHF will have a significant increase in GDMT prescribing over those in the control group, with the potential to decrease admissions, reduce mortality, and reduce costs.