Alert Banners Dramatically Increase Prescribing Rates of Lifesaving Heart Failure Medication
An automated system that flags the patients who could most benefit from an underused yet lifesaving cardiology drug more than doubled new prescriptions, according to a pilot program test by researchers at NYU Grossman School of Medicine.
“Our findings suggest that tailored electronic notifications can boost the prescription of lifesaving drugs,” said study lead author and cardiologist Amrita Mukhopadhyay, MD, a clinical instructor in the Department of Medicine. “By compiling key information in one place, the system may help providers spend less time searching through medical records during a visit and more time speaking with their patients.”
The trial applied the new tool to heart failure, during which the heart is increasingly unable to pump enough blood. Medications called mineralocorticoid receptor antagonists (MRAs) can greatly increase survival rates, but past studies had shown that almost two-thirds of eligible patients are not prescribed these drugs. Other research has blamed this treatment gap for more than 20,000 preventable deaths each year in the United States.
According to the study team, part of the challenge in prescribing MRAs is that the medical information needed to determine a patient’s eligibility is scattered throughout their electronic health record. As a result, experts have been exploring the use of digital messaging tools that automatically analyze standard clinical guidelines and relevant medical data to make treatment decisions easier.
The study was presented at the annual conference of the American College of Cardiology (ACC) on March 5 and was simultaneously published in the association’s journal, JACC. According to its authors, the study is the first to directly compare the effectiveness of alert message types that address heart failure.
In a pilot program designed to find the most effective type of digital alert, researchers at NYU Grossman School of Medicine tested two automated technologies over six months. First, the records of more than 2,220 men and women in treatment for heart failure were screened. The results showed that cardiologists who received a banner-like alert on their computer screen prescribed MRA therapy for about 30 percent of their patients over the course of the trial. Those who were instead sent monthly email-like messages did so roughly 16 percent of the time. By contrast, those who received neither type of message prescribed the therapy for 12 percent of their patients.
Between April and October 2022, the research team tested the notification systems at more than 60 cardiology outpatient clinics that were part of NYU Langone. Adults with heart failure were randomly divided into three groups, determined by the type of support tool used by their cardiologist.
In the first group, alerts appeared on the top corner of patient healthcare charts, which are routinely reviewed during visits. They included data that may inform decisions about MRA therapy, such as blood pressure, estimated glomerular filtration rate (a measure of kidney function), and potassium levels in the blood.
Dr. Mukhopadhyay notes that the researchers wanted to avoid overwhelming physicians with too many prompts. To prevent alarm fatigue, the alert was designed to exclude anyone who might be harmed by MRA treatment, such as those with certain kidney disorders or those who were already taking the medications.
For the second group of patients, cardiologists received a monthly message within the healthcare system’s internal messaging platform that included a list of those eligible for MRAs. Through this “email,” healthcare providers could open medical charts and read information relevant for prescribing MRAs.
“Even though monthly ‘emails’ limit interruptions during a consultation, alerts may be more effective because they allow physicians to discuss a recommended treatment in real time,” said study senior author Saul B. Blecker, MD.
Dr. Blecker, an associate professor in the Departments of Medicine and Population Health, cautions that the technologies were only tested in cardiology practices within a large urban healthcare system. As a result, Dr. Blecker said the team next plans to explore the effectiveness of these tools in other settings, such as primary care practices and smaller clinics.
Funding for the study was provided by National Institutes of Health grants UL1TR001445 and 2T32HL098129-11. Further funding was provided by Allen Thorpe.
In addition to Dr. Mukhopadhyay and Dr. Blecker, other NYU Langone investigators involved in the study were Harmony R. Reynolds, MD; Lawrence Phillips, MD; Arielle R. Nagler, MD; William King, MS; Adam C. Szerencsy, DO; Archana Saxena, MD; Rod Aminian, MPH; Nathan Klapheke, BS; Leora Horwitz, MD; and Stuart D. Katz, MD.