An electronic alert system didn't get physicians to prescribe more guideline-directed meds at discharge for their patients hospitalized with acute HF in a randomized trial.
prescriptions 30 days after discharge compared to usual care, Ahmad observed in his presentation.
The study enrolled 920 adults with acute HF, an EF 40% or lower , and NT-proBNP levels higher than 500 pg/mL. The patients received IV diuretics for the first 24 in-hospital hours and were not taking medications from any of the four core HF drug classes. Their mean age was 74, 36% were women, and 25% were Blacks.
"There was absolutely no evidence that the alert made any difference. There were zero patients on all four classes of GDMT at baseline, and at the time of discharge, only 11.2% of patients were on all four pillars ― essentially, 1 in 9 patients," Ahmad said. Nor were there any subgroup differences in age, sex, race, ejection fraction, type of health insurance, or whether care was provided by a cardiologist or noncardiologist physician.
Responding do a post-presentation question on whether the post-discharge phase might be a more effective time to intervene with nudges, Ahmad observed that many clinicians who care for patients in the hospital assume that someone else will have the patient receive appropriate meds after discharge."But we know that things that are started in the hospital tend to stick better.
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