Evaluating Electronic Health Record Intervention Efficacy in Enhancing Inpatient Initiation of Guideline-Directed Medical Therapy
Abstract
BACKGROUND
Heart failure (HF) is a leading cause of hospitalization, morbidity, and mortality. Despite evidence supporting guideline-directed medical therapy (GDMT), prescribing remains suboptimal, particularly at hospital discharge.
PROJECT RATIONALE
Hospitalization provides an opportunity to initiate or optimize GDMT, but workflow barriers and practice variation limit implementation. To address this gap, our system implemented a system-wide HF quality improvement initiative featuring evidence-based order sets and an electronic health record smart phrase ("HFNOTE") to centralize and standardize documentation and encourage GDMT use.
PROJECT SUMMARY
We analyzed 2,859 HF hospitalizations across 10 hospitals between December 1, 2024 and June 30, 2025. Use of HFNOTE and admission order sets was significantly associated with higher rates of 4-pillar GDMT prescribing in heart failure with reduced ejection fraction/heart failure with improved ejection fraction and sodium-glucose cotransporter-2 inhibitor prescribing in heart failure with preserved ejection fraction/heart failure with mildly reduced ejection fraction, with relative improvements ranging from 31% to 58%.
TAKE-HOME MESSAGES
Scalable electronic health record-based tools, including standardized order sets and documentation, may meaningfully improve adherence to evidence-based HF therapy.
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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