Targeted EHR alerts nearly double prescribing of heart failure therapy

Clinical takeaway: Review mineralocorticoid receptor antagonist eligibility in patients with heart failure with reduced ejection fraction (HFrEF) who remain untreated. Consider targeted EHR prompts that display relevant clinical data and link directly to medication and laboratory orders.

Mineralocorticoid receptor antagonists (MRAs) reduce mortality and hospitalization in HFrEF, yet only about one-quarter of eligible patients receive them. A multicenter trial tested whether an electronic alert previously successful at one institution could help close this gap elsewhere.

Within 30 days, 17.9% of patients in the alert group received a new MRA prescription, compared with 9.2% receiving usual care. After accounting for clustering by clinician and health system, prescribing increased by 89%, with one additional prescription for every 14 patients exposed to the alert strategy.

The prompt brought together ejection fraction, potassium, kidney function, blood pressure, and current medications, alongside links to treatment and laboratory orders. It appeared selectively for patients identified as eligible, helping limit unnecessary reminders.

Hyperkalemia occurred in 11.5% of the alert group versus 12.2% with usual care, without a significant difference. Prescribing of other recommended heart failure therapies did not improve.

The cluster-assigned trial included 1,136 adults seen by 272 cardiology providers across three US health systems using Epic. Participants had an ejection fraction ≤40%, no active MRA prescription, and no electronically identified contraindication. Assignment depended on the clinician’s National Provider Identifier.

The alert package can be made available to other Epic institutions. Future research should assess sustained treatment use and longer-term clinical outcomes, which this trial did not evaluate.

“Our findings highlight the potential for future, large-scale EHR-based improvement strategies to reduce shortfalls in care across varied settings and institutions,” the authors concluded.

Source: Mukhopadhyay A, et al. (2026 Nov 8) JACC Heart Fail. A Multi-Center Cluster-Assigned Trial of Electronic Alerts to Improve Prescribing of Mineralocorticoid Receptor Antagonist Therapy for Heart Failure