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.