Abstract 11995: Clinical Reminders to Providers of Patients with Depressed Left Ventricular Ejection Fraction Increase Defibrillator Implantation: A Randomized Trial
Background: Implantable defibrillators are underutilized even though they have been shown to prolong survival in appropriate patients with depressed left ventricular ejection fraction (LVEF). The primary goal of this study was to test the efficacy of a clinical reminder directed to providers of patients with LVEF ≤ 35% in improving defibrillator implantation.
Methods: We queried the database of all consecutive echocardiograms obtained from January 2007 through July 2010 in the VA Palo Alto healthcare system to identify patients with LVEF ≤ 35% on their most recent echocardiogram. Patients were excluded if they already had a defibrillator, if they were ≥ 80 years old, or if they currently did not have an identified primary care or cardiology provider within the healthcare system. We randomized qualifying patients to no intervention or a clinical reminder intervention, which was a note stating potential eligibility for defibrillator implantation placed in the intervention patient's electronic medical record (EMR) with EMR-based notification to the primary care and/or cardiology provider requiring co-signature. A trained adjudicator ascertained the following outcomes after six months of randomization: 1) referral for defibrillator implantation (primary outcome); and 2) provider documentation discussing potential candidacy.
Results: Of 332 patients with LVEF ≤ 35%, 128 patients already had a defibrillator, 85 were no longer followed at the VA Palo Alto healthcare system, and 28 were ≥ 80 years old, leaving 89 patients to be randomized. 46 patients were randomized to intervention and 43 to control. 11 of 46 (24%) intervention patients were referred for defibrillators versus 1 of 43 (2%) control patients (p=0.004). Overall, 32 of 46 (70%) intervention patients versus 22 of 43 (51%) control patients had documentation discussing potential candidacy for defibrillators (p=0.09).
Conclusions: In patients with low LVEF, a simple electronic medical record-based intervention directed to their care providers improves the rates of appropriate defibrillator implantation.
- © 2011 by American Heart Association, Inc.