Provider Notification for High B-type Natriuretic Peptide Values

Not Applicable

Completed

• Conditions: Heart Failure
• Interventions: Other: Clinical Reminder

• Registration Number: NCT01734135
• Lead Sponsor: VA Palo Alto Health Care System

Brief Summary

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.

Detailed 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.

Study Timeline

• Study Start: 2010-10
• Study First Submitted: 2012-11-20
• Study First Submitted QC: 2012-11-20
• Study First Posted: 2012-11-27
• Primary Completion: 2013-09
• Study Completion: 2015-09
• Status Verified: 2016-04
• Last Update Submitted: 2016-04-26
• Last Update Posted: 2016-04-28

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 115

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%

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Clinical Reminder	Clinical Reminder	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.

Primary Outcome Measures

Name	Time	Method
Measurement of left ventricular ejection fraction	6 months after randomization	numerator: Measurement of left ventricular ejection fraction within 6 months of randomization.; denominator: All randomized patients

Secondary Outcome Measures

Name	Time	Method
Treatment of Low LVEF	6 months following randomization	Numerator: number of patients with an LVEF \< 40% and treatment with either an angiotensin converting enzyme inhibitor, angiotensin receptor blocker or evidence based beta-blocker (carvedilol, metoprolol succinate, bisoprolol).; Denominator: all randomized patients.
Identification of LVEF < 40%	6 months following randomizaiton	Numerator: number of patients identified with an LVEF\< 40% Denominator: all randomized patients

Trial Locations

Locations (1)

VA Palo Alto Health Care System; 🇺🇸 Palo Alto, California, United States