Clinical decision support app helps improve quality of life and longevity for heart failure patients

December 19, 2017

A clinical decision support application developed by Intermountain Healthcare researchers that more quickly identifies when heart failure becomes advanced and a heart patient's care needs have changed is successful in helping to improve patient's quality of live and longevity, according to a new study.

The new app, which monitors heart failure patients' medical tests and health status and promptly notifies clinicians, was developed by a multidisciplinary team of Intermountain Healthcare medical informatics specialists, home health experts, and clinicians from the Intermountain Medical Center Heart Institute in Salt Lake City.

Using the app during the study, researchers found that it led to significantly improved detection of disease advancements. For instance, intervention patients' survival rates increased. More intervention patients were alive compared to a control group at key intervals: 30 days (95% vs. 92%), 60 days (95% vs. 90%), 90 days (94% vs. 87%) and 180 days (92% vs. 84%).

Findings of a study on the effectiveness of the new app are published in the Journal of Cardiac Failure.

"We found that clinical decision support can facilitate the early identification of patients needing advanced heart failure therapy and that its use was associated with significantly more patients visiting specialized heart facilities and longer survival," the study said.

More than six million Americans have heart failure, which means their heart fails to adequately pump blood. That results in an array of symptoms that include fatigue, shortness of breath, swelling, and a fast or erratic heartbeat.

"Heart failure is progressive, and when it becomes advanced, standard therapies are no longer adequate and quality of life plummets," said study lead author R. Scott Evans, MS, PhD, 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."

"But patients typically aren't monitored every day and it's hard for doctors to stay up to date on all the research regarding heart failure," he said. "Plus, no single test says the disease has progressed and often patients don't end up in advanced heart failure clinics when they should."

Frustrated by seeing heart failure patients weeks or even months after their symptoms progressed, cardiovascular specialists from the Intermountain Medical Center Heart Institute teamed up with technology experts to create a computer program that would monitor heart failure patients to determine when they need advanced care.

Dr. Evans said the advanced heart failure specialists used their own clinical expertise, along with 2013 American College of Cardiology Foundation/American Heart Association criteria for advanced heart failure, then worked with informatics experts to create and refine three algorithms the computer could apply as it monitored patients daily.

Using heart failure patients in Intermountain Healthcare's Salt Lake County community, the computer first identified those with new echocardiograms that showed a left ventricular ejection fraction of less than 35 percent, which is the cut-off that indicates a patient's condition is deteriorating.

The computer app then begins to monitor their records for relevant signs of progression, such as visits to the hospital or emergency department, lab tests, use of diuretics, technological assistance like left ventricular support, data from EKGs, and more. The mined data was then applied to the algorithms.

When computer monitoring indicates a patient likely has advanced heart failure, the app automatically sends a secure email to the patient's doctors -- such as the primary care physician, cardiologist, or the provider who ordered the left ventricular ejection fraction test.

The email includes the recommended therapy and all the relevant information that triggered the alert, and provides a link to a secure Intermountain web-based page that provides further information. It also lists phone numbers and links so doctors can easily connect the patients with advanced heart failure specialists.

Doctors who don't want further notification about a specific patient (who is no longer their patient or who has chosen palliative care, for example) are easily removed from the notification.

Negative reaction has been rare, Dr. Evans said. "No one's asked to be removed because it's a nuisance or not valid information," he said. "Instead, more patients were directed into advanced therapy, where their condition and longevity improved compared to the control group."

For controls, the researchers looked at patients from the previous two years -- who would have been the subject of the clinical decision support app, had it existed, but who were instead retrospectively identified -- and compared their outcomes.
-end-
Besides Dr. Evans, study authors include: Abdallah G. Kfoury, MD; Benjamin D. Horne, PhD, MStat, MPH; James F. Lloyd, BS; Jose Benuzillo, BS; Kismet D. Rasmusson, RN, NP; Colleen Roberts, MS, RN; and Donald L. Lappé, MD.

Intermountain Medical Center

Related Heart Failure Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Machining the heart: New predictor for helping to beat chronic heart failure
Researchers from Kanazawa University have used machine learning to predict which classes of chronic heart failure patients are most likely to experience heart failure death, and which are most likely to develop an arrhythmic death or sudden cardiac death.

Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.

Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population

Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure
A randomized controlled study recently published in the Hypertension issue of Ethnicity & Disease found the Transcendental Meditation (TM) technique helps prevent abnormal enlargement of the heart compared to health education (HE) controls.

Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.

Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.

Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.

How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.

Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

Read More: Heart Failure News and Heart Failure Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.