Evaluating Strategies to Improve Guideline Directed Medical Therapy: The GDMT Research, Education & Assist Trial for Heart Failure Care (GREAT-HF Care)
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ClinicalTrials.gov Identifier: NCT05990296 |
Recruitment Status :
Recruiting
First Posted : August 14, 2023
Last Update Posted : March 6, 2024
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Condition or disease | Intervention/treatment | Phase |
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Heart Failure Heart Failure With Reduced Ejection Fraction | Behavioral: Multiprong CDS with referral to pharmacist co-management Behavioral: Multiprong CDS with GDMT order set Behavioral: Focused education | Not Applicable |
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 4300 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Intervention Model Description: | This is a cluster randomized (at clinician level) design in terms of assignment to no-intervention control, multiprong CDS with GDMT order set, and multiprong CDS with referral to pharmacist co-management, and non-randomized (at clinic level) in terms of assignment to education versus delayed education arms. |
Masking: | None (Open Label) |
Primary Purpose: | Health Services Research |
Official Title: | Evaluating Strategies to Improve Guideline Directed Medical Therapy: The GDMT Research, Education & Assist Trial for Heart Failure Care (GREAT-HF Care) |
Actual Study Start Date : | August 1, 2023 |
Estimated Primary Completion Date : | December 2024 |
Estimated Study Completion Date : | January 2025 |
Arm | Intervention/treatment |
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No Intervention: Control
Clinicians in this arm will not receive CDS or focused education and will experience usual care.
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Experimental: Multiprong CDS with GDMT order set
Clinicians and patients with HFrEF in this arm will receive electronic notification of GDMT care gaps encouraging treatment options. The CDS will inform, encourage, and facilitate prescribing of GDMT via a focused order set.
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Behavioral: Multiprong CDS with GDMT order set
Accepting the clinician-facing BPA default recommendation will open an order set for GDMT that lists common recommended options in such a way that facilitates optimal prescribing. Clinicians will also be exposed to an interruptive advisory upon chart entry as a notification to physicians on GDMT consideration. Patient responses to a pre-visit questionnaire encouraging them to ask about better treatment options will also be shown to clinicians within the interruptive BPA if completed in advance by the patient.
Other Names:
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Experimental: Multiprong CDS with referral to pharmacist co-management
Clinicians and patients with HFrEF in this arm will receive electronic notification of GDMT care gaps encouraging treatment options. The clinician-facing BPA will include an option to refer patients to embedded pharmacist co-management. Pharmacists are expected to meet with patients and optimize GDMT through a collaborative practice agreement with clinicians.
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Behavioral: Multiprong CDS with referral to pharmacist co-management
Accepting the clinician-facing BPA default recommendation will have eligible patients within this arm referred to embedded pharmacist co-management. Pharmacists are expected to meet with patients and optimize GDMT through a collaborative practice agreement with clinicians. Clinicians will also be exposed to an interruptive advisory upon chart entry as a notification to physicians on GDMT consideration. Patient responses to a pre-visit questionnaire encouraging them to ask about better treatment options will also be shown to clinicians within the interruptive BPA if completed in advance by the patient.
Other Names:
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Experimental: Focused education
Clinicians in this arm will receive focused education and no CDS.
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Behavioral: Focused education
A series of focused, interactive education sessions will train clinicians in why, when, and how to prescribe GDMT to patients, with incentives such as continuing medical education (CME) credits, and with virtual and recorded options available to those who are unable to attend in-person meetings.
Other Names:
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Experimental: Multiprong CDS with GDMT order set + focused education
Clinicians in this arm will receive focused education in addition to clinician BPA heads-up and BPA with GDMT order set for their eligible patients with HFrEF.
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Behavioral: Multiprong CDS with GDMT order set
Accepting the clinician-facing BPA default recommendation will open an order set for GDMT that lists common recommended options in such a way that facilitates optimal prescribing. Clinicians will also be exposed to an interruptive advisory upon chart entry as a notification to physicians on GDMT consideration. Patient responses to a pre-visit questionnaire encouraging them to ask about better treatment options will also be shown to clinicians within the interruptive BPA if completed in advance by the patient.
Other Names:
Behavioral: Focused education A series of focused, interactive education sessions will train clinicians in why, when, and how to prescribe GDMT to patients, with incentives such as continuing medical education (CME) credits, and with virtual and recorded options available to those who are unable to attend in-person meetings.
Other Names:
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Experimental: Multiprong CDS with referral to pharmacist co-management + focused education
Clinicians in this arm will receive focused education along with clinicians/patient CDS. The clinician-facing BPA will include an option to refer patients to embedded pharmacist co-management. Pharmacists are expected to meet with patients and optimize GDMT through a collaborative practice agreement with clinicians.
|
Behavioral: Multiprong CDS with referral to pharmacist co-management
Accepting the clinician-facing BPA default recommendation will have eligible patients within this arm referred to embedded pharmacist co-management. Pharmacists are expected to meet with patients and optimize GDMT through a collaborative practice agreement with clinicians. Clinicians will also be exposed to an interruptive advisory upon chart entry as a notification to physicians on GDMT consideration. Patient responses to a pre-visit questionnaire encouraging them to ask about better treatment options will also be shown to clinicians within the interruptive BPA if completed in advance by the patient.
Other Names:
Behavioral: Focused education A series of focused, interactive education sessions will train clinicians in why, when, and how to prescribe GDMT to patients, with incentives such as continuing medical education (CME) credits, and with virtual and recorded options available to those who are unable to attend in-person meetings.
Other Names:
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- HF GDMT prescription increased (yes/no) [ Time Frame: Within 30 days of index visit ]New GDMT HF medication class added, switch to ARNI from ACE/ARB, or upward dose titration of existing GDMT HF medication.
- HF GDMT prescription increased (yes/no) [ Time Frame: Within 60 and 90 days of index visit ]New GDMT HF medication class added, switch to ARNI from ACEi/ARB, or upward dose titration of existing GDMT HF medication.
- Addition of SGLT2i or ARNI for HFrEF (yes/no) [ Time Frame: Within 30, 60 and 90 days of index visit ]New prescriptions for SGLT2i and/or ARNI or switch from ACEi/ARB to ARNI
- All-cause mortality, emergency visit for heart failure or hospitalization for heart failure [ Time Frame: Within 365 days of index visit ]Patient death (yes/no), patient with emergency visit with a primary diagnosis of heart failure (yes/no) or admitted for inpatient hospitalization with primary diagnosis of heart failure (yes/no)
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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Patients aged 18 years or older AND
- Completed visit at included Geisinger cardiology outpatient clinics (office visit or telemedicine) AND
- Clinicians are on a list of currently active Geisinger clinicians in outpatient cardiology clinics who can prescribe heart failure medications AND
- Active problem list diagnosis of HFrEF at time of Cardiology clinic encounter OR Left Ventricular Ejection Fraction (LVEF) < 40: most recent to the cardiology clinic encounter within 2 years of the visit.
Exclusion Criteria:
- Currently in hospice or palliative care (ICD 10 code: Z51.5)
- Patient is allergic to or prescribed medications from all four categories of GDMT
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05990296
Contact: Stephen J Voyce | 5707034830 | svoyce@geisinger.edu | |
Contact: Vanessa A Hayduk | vhayduk@geisinger.edu |
United States, Pennsylvania | |
Geisinger Cardiology Clinics | Recruiting |
Danville, Pennsylvania, United States, 17822 | |
Contact: Stephen J Voyce 570-703-4830 svoyce@geisinger.edu | |
Contact: Vanessa Hayduk 570-714-6682 vhayduk@geisinger.edu | |
Sub-Investigator: Eric Wright, PharmD, MPH | |
Sub-Investigator: Amir Goren, PhD | |
Sub-Investigator: Apoorva Pradhan, MD, MPH |
Responsible Party: | Stephen Voyce, Associate Professor, Geisinger Clinic |
ClinicalTrials.gov Identifier: | NCT05990296 |
Other Study ID Numbers: |
2023-1031 |
First Posted: | August 14, 2023 Key Record Dates |
Last Update Posted: | March 6, 2024 |
Last Verified: | March 2024 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Heart Failure with Reduced Ejection Fraction Guideline Directed Medical Therapy Angiotensin-neprilysin inhibitors (ARNI) Sodium-glucose cotransporter 2 inhibitors (SGLT2i) Clinical Decision Support |
Best Practice Alert Pharmacist Education Behavioral Economics Best Practice Advisory |
Heart Failure Heart Diseases Cardiovascular Diseases |