Medical Informatics, Intermountain Healthcare, Salt Lake City, Utah; Biomedical Informatics, University of Utah, Salt Lake City, Utah;; Intermountain Healthcare Cardiovascular Clinical Program, Salt Lake City, Utah;.
Intermountain Healthcare Cardiovascular Clinical Program, Salt Lake City, Utah;; Intermountain Heart Institute, Intermountain Medical Center. Salt Lake City, Utah.
J Card Fail. 2017 Oct;23(10):719-726. doi: 10.1016/j.cardfail.2017.08.449. Epub 2017 Aug 16.
Patients who need and receive timely advanced heart failure (HF) therapies have better long-term survival. However, many of these patients are not identified and referred as soon as they should be.
A clinical decision support (CDS) application sent secure email notifications to HF patients' providers when they transitioned to advanced disease. Patients identified with CDS in 2015 were compared with control patients from 2013 to 2014. Kaplan-Meier methods and Cox regression were used in this intention-to-treat analysis to compare differences between visits to specialized and survival.
Intervention patients were referred to specialized heart facilities significantly more often within 30 days (57% vs 34%; P < .001), 60 days (69% vs 44%; P < .0001), 90 days (73% vs 49%; P < .0001), and 180 days (79% vs 58%; P < .0001). Age and sex did not predict heart facility visits, but renal disease did and patients of nonwhite race were less likely to visit specialized heart facilities. Significantly more intervention patients were found to be alive at 30 (95% vs 92%; P = .036), 60 (95% vs 90%; P = .0013), 90 (94% vs 87%; P = .0002), and 180 days (92% vs 84%; P = .0001). Age, sex, and some comorbid diseases were also predictors of mortality, but race was not.
We found that CDS can facilitate the early identification of patients needing advanced HF therapy and that its use was associated with significantly more patients visiting specialized heart facilities and longer survival.
需要并接受及时的心力衰竭（HF）先进治疗的患者具有更好的长期生存率。然而，许多这样的患者并没有尽早被识别和转介。
当 HF 患者的病情进展为晚期时，临床决策支持（CDS）应用程序会向他们的提供者发送安全电子邮件通知。将 2015 年使用 CDS 的患者与 2013 年至 2014 年的对照组患者进行比较。本意向治疗分析采用 Kaplan-Meier 方法和 Cox 回归比较了就诊专科和生存差异。
干预组患者在 30 天内（57% vs 34%；P <.001）、60 天内（69% vs 44%；P <.0001）、90 天内（73% vs 49%；P <.0001）和 180 天内（79% vs 58%；P <.0001）转介至专科心脏设施的比例显著更高。年龄和性别不能预测心脏设施就诊情况，但肾脏疾病可以预测，非白人种族的患者更不可能就诊于专科心脏设施。干预组患者在 30 天（95% vs 92%；P =.036）、60 天（95% vs 90%；P =.0013）、90 天（94% vs 87%；P =.0002）和 180 天（92% vs 84%；P =.0001）时的存活率显著更高。年龄、性别和一些合并症也是死亡的预测因素，但种族不是。
我们发现 CDS 可以促进对需要先进 HF 治疗的患者的早期识别，其使用与更多患者就诊于专科心脏设施和更长的生存时间显著相关。
