TAILORD electronic intervention to improve therapy in a diverse cohort of patients with heart failure (TAILORD-HF): Study protocol

BACKGROUND: Evidence-based guideline directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF) is under-prescribed. Decision support tools have been studied to help bridge the gap between clinical evidence and real-world use for GDMT with mixed success. This paper describes a trial of modified GDMT checklist that is distributed to both patients and clinicians with the aim of evaluating its impact on GDMT intensification and identifying modifiable barriers and facilitators for its use. HYPOTHESIS: GDMT intensification will be increased by delivering an evidence-based checklist through the electronic medical record. DESIGN: TAILORD-HF is a trial conducted within one academic health system using a two-phase clinic-level parallel cluster randomized design. In Phase 1, patients in intervention clinics will receive the modified GDMT checklist via portal message. In Phase 2, clinicians in intervention clinics will also see an analogous GDMT list via EMR display. The primary outcome is intensification of GDMT. Clinicians and patients are interviewed to assess their experience with the checklist. DISCUSSION: TAILORD-HF will provide insights on the impact of a modified GDMT checklist on GDMT intensification in a real-world clinic population of patients with HFrEF. Additionally, the trial will provide novel information on patient and clinician perspectives regarding decision tools for GDMT intensification. Findings will enhance understanding of how to effectively deliver an EMR intervention for patients with HFrEF to address unmet needs around GDMT optimization, and in conjunction with other ongoing trials, deepen understanding of how to improve care of patients with heart failure.