Evaluating Strategies to Improve Guideline Directed Medical Therapy: The GDMT Research, Education & Assist Trial for Heart Failure Care

Last updated: March 10, 2025
Sponsor: Geisinger Clinic
Overall Status: Active - Recruiting

Phase

N/A

Condition

Congestive Heart Failure

Chest Pain

Heart Failure

Treatment

Pharmacist co-management

Focused education

Multiprong CDS with referral to pharmacist co-management

Clinical Study ID

NCT05990296
2023-1031
  • Ages > 18
  • All Genders

Study Summary

Heart failure with reduced ejection fraction (HFrEF) is associated with high mortality and adverse events (hospitalization or urgent outpatient visits for HF), along with diminished quality of life. Despite convincing data that evidenced-based, guideline-directed medical therapies (GDMT) improve mortality and heart failure-related events, there remains insufficient utilization of these life-saving drugs (evidence-based beta-blockers (EBBB), angiotensin-neprilysin inhibitors (ARNI)/ angiotensin converting enzyme inhibitors (ACEi)/ angiotensin receptor blockers (ARB), mineralocorticoid receptor antagonists (MRA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with HFrEF. The primary objective of this study is to implement and evaluate a multifaceted, interdisciplinary intervention to improve GDMT use, reduce mortality, and reduce future heart failure events in patients with HFrEF.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Patients aged 18 years or older AND

  • Completed visit at included Geisinger cardiology outpatient clinics (office visit ortelemedicine) AND

  • Clinicians are on a list of currently active Geisinger clinicians in outpatientcardiology clinics who can prescribe heart failure medications AND

  • Active problem list diagnosis of HFrEF at time of Cardiology clinic encounter ORLeft Ventricular Ejection Fraction (LVEF) < 40: most recent to the cardiology clinicencounter within 2 years of the visit.

Exclusion

Exclusion Criteria:

  • Currently in hospice or palliative care (ICD 10 code: Z51.5)

  • Patient is allergic to each category of GDMT

  • Patient is prescribed medications from all four categories of GDMT, including ARNIspecifically

Study Design

Total Participants: 4300
Treatment Group(s): 6
Primary Treatment: Pharmacist co-management
Phase:
Study Start date:
August 01, 2023
Estimated Completion Date:
August 17, 2025

Study Description

This is a cluster randomized study designed to evaluate the effectiveness of interventions aimed at improving GDMT in patients with HFrEF. Clinicians stratified based on practice specialty, location, and pharmacist referral habits will be permuted block randomized to achieve 45%/45%/10% proportional distribution across the following arms respectively: (1) usual care, (2) multi-pronged clinical decision support (CDS) inclusive of a patient portal message about GDMT, an interruptive advisory upon chart entry as a notification to clinicians on GDMT consideration and a Best Practice Advisory (BPA) that includes a GDMT order set, and (3) multi-pronged CDS as in #2 but replacement of GDMT order set with referral to integrated clinical pharmacist co-management. Secondarily, each of the 5 clinical practice sites of roughly equal HFrEF patient loads were assigned to receive either an early or delayed education rollout. Exploratory analyses will look to determine the independent and incremental benefits of education with other interventional approaches.

Connect with a study center

  • Geisinger Cardiology Clinics

    Danville, Pennsylvania 17822
    United States

    Active - Recruiting

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