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Facilitators, barriers, and insights using an HFA-PEFF-based clinical decision support system: A proof-of-concept
Isidora Milosavljević1,2, Ivan Petrović1,3, Aleksandra Ilić1,4
1Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
ESC Heart Failure
|August 15, 2025
Summary
A new clinical decision support system (CDSS) aids in diagnosing heart failure with preserved ejection fraction (HFpEF). Physician education on HFpEF and CDSS use is crucial for effective implementation.
Area of Science:
- Cardiology
- Medical Informatics
Background:
- Heart failure with preserved ejection fraction (HFpEF) presents diagnostic challenges.
- A clinical decision support system (CDSS) integrating functional, morphological, and biomarker data was developed to address these challenges.
Purpose of the Study:
- To evaluate the implementation feasibility of a CDSS for HFpEF.
- To assess physician adherence to CDSS recommendations.
- To identify barriers and facilitators influencing CDSS adoption.
Main Methods:
- A mixed-methods study combining retrospective patient data analysis and a prospective electronic physician survey.
- Utilized the Heart Failure Association pre-test assessment, echocardiography, natriuretic peptide, functional testing, and final aetiology (HFA-PEFF) score to build and validate the CDSS.
- Collected physician feedback on CDSS usability and perceived effectiveness.
Main Results:
- Out of 225 patients with ejection fraction (EF) ≥50%, 194 (86.2%) had a high probability of HFpEF, but only 32 (16.5%) were formally diagnosed.
- Physician survey (83.3% response rate) revealed barriers like limited echocardiographic skills and HFpEF phenotype knowledge.
- Facilitators included enhancing CDSS explainability, transparency, and providing staff education.
Conclusions:
- The CDSS shows promise in diagnosing and classifying HF patients with EF ≥50%.
- Physician education in CDSS utilization and HFpEF-specific knowledge is essential for successful clinical integration and improved patient outcomes.
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