The use of multidisciplinary teams, electronic health records tools, and technology to optimize heart failure population health

Abstract

Purpose of reviewGiven the limited population level, adoption of optimal therapy that has been shown in recent clinical trials and heart failure registries, efforts to rapidly and safely improve adoption of guideline-directed medical therapy for heart failure should be prioritized. Opportunities to leverage remote monitoring technology, the electronic health record (EHR), and multidisciplinary teams to improve heart failure care merit review. Recent findingsDedicated multidisciplinary teams employing algorithmic medication titration schema have shown better efficacy than clinician alerts or quality initiatives that focus on education and audit-feedback processes alone. Technology that enables invasive pressure monitoring and wearable devices that transmit physiologic data have the potential to predict decompensation and allow for early intervention by alerting clinicians to signs of congestion/clinical worsening but further real-world data is needed to prove efficacy and develop effective treatment protocols.

Novel Strategies to Improve Prescription of Guideline-Directed Medical Therapy in Heart Failure

“…With remote data acquisition and interpretation, clinicians can be notified of changes in patient status, especially as it relates to congestion, allowing for early intervention in the cascade of acute or worsening heart failure [ 38 ]. Wearable or implantable electronic devices and invasive pressure monitors may be able to reduce barriers to cardiovascular care by remotely assessing symptoms, activity level, and volume status to help reduce the risk of decompensation [ 19 , 39 ]. Remote monitoring of PA pressure, LA pressure, chest impendence, IVC size, and others have been developed [ 40 , 41 ].…”

“…Despite multiple proposed strategies for the sequencing of HF medical therapy, challenges of transforming clinical practice persist [ 13 – 17 ]. Electronic health record (EHR)-embedded alerts, patient registries, and multidisciplinary team-based approaches are being incorporated at numerous centers to help define and ameliorate this gap [ 18 •, 19 , 20 ]. The advent of multiple remote patient monitoring devices, more robust integrated healthcare system data, and machine learning may be pathways to improving care.…”

The utilization and impact of cardiovascular specialists on guideline‐directed medical scores: An analysis of a diverse, multi‐state, electronic health record‐based registry

“…As new therapies and evidence emerge, health systems equipped with HF‐specific EHR‐based population health capabilities will be poised to facilitate implementation, analyse metrics, and ensure appropriate access to care as well as understand system disparities in HF therapies 12 . Cardiology encounters, particularly those with HF specialists, were significantly associated with the prescribing of newer and older GDMT, as well as the use of comprehensive therapy as measured by GDMT score, suggesting provider factors remain impactful regardless of therapy novelty.…”