Provider Notification for High B-type Natriuretic Peptide Values

VA Palo Alto Health Care System

Status: Completed

Conditions: Heart Failure

Treatments: Other: Clinical Reminder

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT01734135

CHFQUERI-1101

Details and patient eligibility

About

This proposal examines use of a clinical reminder to the primary provider of patient with a high B type natriuretic peptide but no prior imaging.

Electrical Medical Record-based Intervention to Determine whether Clinical Reminders Improve Heart Failure Management in Patients with High BNP Values and Unknown LVEF.

Full description

Rationale: B type natriuretic peptide is known to be elevated (> 100 pg/ml) in patients with heart failure. Furthermore, treatments are available to improve survival and reduce hospitalization if the left ventricular ejection fraction (LVEF) is < 40%. Accordingly, guidelines recommend an LVEF measure for patients with suspected heart failure. Prior work has demonstrated that patients with high BNP values do not always have a measure of left ventricular ejection.

Hypothesis: A reminder to patients with BNP and no imaging may prompt providers to order appropriate imaging potentially leading to 1) identification of unsuspected depressed ejection fraction and 2) more appropriate treatment.

Enrollment: 115 patients

Sex: All

Ages: 18 to 120 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• BNP >= 200 pg/ml in last 2 months

Exclusion criteria

• Measure of LVEF in the last 12 months
• Last measure of LVEF < 40%

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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115 participants in 2 patient groups

Usual Care

No Intervention group

Description:

Usual care

Clinical Reminder

Experimental group

Description:

A note is sent to the primary care provider using the electronic medical record indicating the high BNP result and potential benefit of measurement of the left ventricular ejection fraction. A draft order is placed for an echocardiogram for the provider to accept or delete.

Treatment:

Other: Clinical Reminder