Smart Heart: Assessing the Impact of an Electronic Health Record Intervention on Guideline-Directed Medical Therapy Prescribing in Heart Failure

Authors

• Shriya Baweja, BSc, Thomas Jefferson UniversityFollow
• Alan Kubey, MD, FACP, Thomas Jefferson UniversityFollow

Document Type

Abstract

Publication Date

2-11-2026

Academic Year

2025-2026

Comments

Presented at the 2026 Scholarly Inquiry (SI) Research Project Symposium.

Abstract

Introduction: Heart failure (HF) affects millions in the U.S., yet guideline-directed medical therapy (GDMT) and the supportive utilization of EHR-based clinical decision support systems (CDSS) for uptake remain underexplored. This project evaluated whether CDSS implementation increased GDMT prescribing at discharge for patients with HFrEF/HFimpEF.

Methods: The analysis included HF patients discharged from 11 hospitals on our enterprise EHR (Epic) from July 2023 to June 2025. Data was extracted from an automated data platform (Qlik). Patients were grouped into matched pre- and post-intervention periods, accounting for seasonality and concurrent financial and multidisciplinary workgroup HF initiatives. CDSS tools implemented in November 2024 included an admission order set, daily order set, and HF- specific progress note. Primary outcomes were mean number of GDMT medications prescribed at discharge; secondary outcomes included four-pillar GDMT use and subgroup analysis by hospital order set adherence.

Results: Among 3,535 patients, average GDMT medications per patient increased significantly: Post 1 vs Pre 1 (2.41 vs 2.24, p=0.0036) and Post 2 vs Pre 2 (2.49 vs 2.32, p< 0.0001). Four-pillar prescribing also improved: Post 1 vs Pre 1 (19.97% vs 12.92%, p=0.0009) and Post 2 vs Pre 2 (22.81% vs 17.70%, p=0.0021). Hospitals with higher order set adherence (65%) demonstrated greater improvement than lower-adherence hospitals (14%), with relative four-pillar prescribing improvements of 47.8% vs 20.9%.

Conclusion: Multimodal quality improvement efforts incorporating EHR-based CDSS were associated with improved GDMT prescribing at discharge. Limitations include the observational design and concurrent system-wide interventions. Future work will focus on improving CDSS adoption and evaluating patient-centered outcomes.

Recommended Citation

Baweja, BSc, Shriya and Kubey, MD, FACP, Alan, "Smart Heart: Assessing the Impact of an Electronic Health Record Intervention on Guideline-Directed Medical Therapy Prescribing in Heart Failure" (2026). Phase 1. Paper 1.
https://jdc.jefferson.edu/si_hs_2028_phase1/1

Language

English