Evaluating Electronic Health Record Intervention Efficacy in Enhancing Inpatient Initiation of Guideline-Directed Medical Therapy.

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.