Reduced Ejection Fraction / Systolic Heart Failure: A Real-World Case Study Using Electronic Health Records
EXECUTIVE SUMMARY
Heart failure is a complex clinical syndrome arising from structural or functional impairments of ventricular filling or ejection of blood. With its increasing prevalence and the aging of the population, the economic burden of heart failure on the US healthcare system is substantial and continues to increase. High morbidity and mortality make heart failure a significant concern for patients and their families. Management is challenging, especially in the presence of comorbidities, which can be risk factors for developing heart failure as well as complicating factors in established heart failure. The gaps in use and dosing of evidence-based, guideline-recommended therapies suggest a care deficit exists such that treatment remains suboptimal for a significant number of heart failure patients.
This paper provides insight into current knowledge regarding heart failure, with an emphasis on systolic (i.e., reduced ejection fraction) heart failure and guideline-directed medical therapy (GDMT). We consider how real-world evidence derived from de-identified patient information available in electronic health record (EHR) platforms may be leveraged to inform and advance appropriate care plans in heart failure. With a focus on new pharmacotherapies, a retrospective case study using real-world data from the EHR platform Practice Fusion, a Veradigm® offering, demonstrates that nearly one third of ambulatory heart failure patients were not receiving at least one GDMT. The study also indicates that new medications specifically approved for the treatment of systolic heart failure may be underutilized despite being important advances in heart failure care management. Future studies that leverage real-world evidence from multiple electronic platforms may provide insight into patient quality of life, hospitalizations, and survival in heart failure.