Key result
EMR-embedded pre-discharge checklist linked to ~61% lower 12-month death or HF hospitalization risk.
Why the study?
In real-world practice, GDMT prescription rates and dosing in HFrEF often remain suboptimal due to clinical inertia during hospital-to-home transitions, motivating evaluation of an EMR-embedded pre-discharge checklist on GDMT optimization and clinical outcomes.
Does an EMR-embedded pre-discharge checklist reduce the composite of all-cause death or heart failure hospitalization at 12 months in patients hospitalized with HFrEF?
Cohort (n=661)
No
Does an EMR-embedded pre-discharge checklist reduce the composite of all-cause death or heart failure hospitalization at 12 months in patients hospitalized with HFrEF?
Implementing an EMR-embedded pre-discharge checklist in hospitalized HFrEF patients significantly improved longitudinal GDMT optimization and reduced the 12-month risk of all-cause death or HF hospitalization by 61%.
Associated with better GDMT and lower HFrEF events; leaves open whether randomized trials confirm benefit.
Background Early initiation and intensification of guideline-directed medical therapy (GDMT) are crucial for patients with heart failure with reduced ejection fraction (HFrEF). However, in real-world practice, GDMT prescription rates and dosing often remain suboptimal due to clinical inertia during hospital-to-home transitions. Purpose To evaluate the impact of electronic medical record (EMR)-embedded DCL on the temporal trajectory of GDMT optimization and its subsequent effect on clinical outcomes. Methods This real-world cohort study included 661 patients hospitalized with HFrEF (LVEF ≤ 40%) at a tertiary academic center. The DCL utilized in this study was adapted from the standardized template provided by the KSHF and integrated into the hospital's EMR system. Patients were categorized into a DCL group (n=369) and a non-DCL group (n=292, comprising historical and concurrent controls). Modified version of the Heart Failure Collaboratory (mHFC) score was calculated and assessed the mHFC score at discharge and longitudinally at 3, 6, and 12 months to evaluate the trajectory of medication titration.The primary outcome was a composite of all-cause death or HF hospitalization at 12 months. Results DCL implementation was associated with significantly higher prescription rates across core GDMT pillars: renin-angiotensin system inhibitors (RASi; 90.2% vs. 69.5%, P < 0.001), beta-blockers (86.2% vs. 72.3%, P < 0.001), and SGLT2 inhibitors (51.2% vs. 12.3%, P < 0.001). Notably, the use of angiotensin receptor-neprilysin inhibitors (ARNI) was substantially higher in the DCL group (82.4% vs. 19.2%, P < 0.001). Consequently, the overall quality of medical therapy, quantified by the mHFC score, was significantly higher in the DCL cohort (5.9 ± 2.2 vs. 3.6 ± 2.0, P < 0.001). Longitudinally, the DCL group consistently maintained these higher prescription rates and optimal dosing trajectories throughout the 12-month follow-up. Consequently, the DCL group was associated with a 61% reduced risk of the primary composite outcome (Adjusted Hazard Ratio 0.39; 95% Confidence Interval 0.25–0.59; P < 0.001), which was primarily driven by a marked reduction in HF readmissions (10.8% vs. 22.9%, P < 0.001). Conclusion An EMR-embedded DCL significantly enhanced the early optimization of GDMT and successfully maintained therapeutic intensity over time and improved event-free survival.figure 1figure 2
No takes yet. Share an insight, caveat, or question.
Jang et al. (2026) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=661). Electronic medical record (EMR)-embedded pre-discharge checklist (DCL) vs. Non-DCL group (historical and concurrent controls) was evaluated on Composite of all-cause death or HF hospitalization at 12 months (Adjusted HR 0.39, 95% CI 0.25-0.59, p=<0.001). An EMR-embedded pre-discharge checklist was associated with a 61% reduced risk of 12-month all-cause death or HF hospitalization (adjusted HR 0.39; 95% CI 0.25-0.59; P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: