App identifies patients needing advanced heart failure therapies

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Intermountain Healthcare has developed a clinical decision support app that tracks heart failure patients and alerts providers when their conditions have changed and require advanced disease therapies.

The CDS app monitors HF patients through echocardiogram results and other health data to identify those eligible for advanced treatment, which ensures earlier referral to a specialized heart facility, resulting in improvements in quality of life and longer survival rates.

The concept for the app was born when clinicians started realizing that many patients who met established guidelines for advanced HF therapies were not being referred as soon as possible to specialized heart facilities, according to R. Scott Evans, medical informatics director at Intermountain Healthcare.

“The sooner advanced heart failure is diagnosed and patients begin to receive advanced, specialized treatment, the better they tend to do,” says Evans. “But it’s hard to really determine when a patient goes from heart failure to advanced heart failure. There’s no single clinical lab test or imaging modality.”

In addition, he points out that “patients typically aren’t monitored every day, and it’s hard for [primary care] doctors to stay up to date on all the research regarding heart failure.”

To address this shortfall, Intermountain Healthcare cardiologists, medical informatics and home health specialists collaborated to develop an app leveraging algorithms to identify potential patients for advanced HF therapies; logic underlying the algorithms is based on the 2013 American College of Cardiology Foundation and American Heart Association guideline for the management of heart failure.

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Specifically, the app is designed identify patients with echocardiogram results showing a left ventricular ejection fraction of less than 35 percent, which is the threshold indicating the deterioration of a patient’s condition. When those kinds of patients are identified, the app then captures a plethora of other data— including lab test results, diuretic use and hospitalization and emergency room visits from Intermountain Healthcare’s electronic health record system—to help determine disease progression.

If the app determines that a patient has advanced heart failure, it automatically generates a secure email to the patient’s primary care physician, cardiologist (if they have one) or the clinician (if different) who ordered the echocardiogram. The email includes the recommended advanced HF therapies and all the data on the different patient-specific risk factors used to generate the notification, as well as a hyperlink to a secure Intermountain website with further information and phone numbers to access specialist care.

A study on the efficacy of the app, recently published in the Journal of Cardiac Failure, found that it led to significantly improved detection of disease advancement.

Specifically, compared with a control group, intervention patients were referred to specialized heart facilities significantly more often within 30 days (57 percent vs. 34 percent), 60 days (69 percent vs. 44 percent), 90 days (73 percent vs. 49 percent), and 180 days (79 percent vs. 58 percent). Further, significantly more intervention patients were alive compared to a control group at key intervals: 30 days (95 percent vs. 92 percent), 60 days (95 percent vs. 90 percent), 90 days (94 percent vs. 87 percent) and 180 days (92 percent vs. 84 percent).

“We found that CDS can facilitate the early identification of patients needing advanced HF therapy and that its use was associated with significantly more patients visiting specialized heart facilities and longer survival,” concluded Evans, the lead author, and his co-authors.

As a result, Evans says the app is currently being used across the Intermountain Healthcare enterprise, which includes 22 hospitals and 197 clinics, urgent care centers, and physician offices. “It’s monitoring patients every day and everywhere.”

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