Alert-Based Computerized Decision Support to Increase Screening for Pulmonary Hypertension after Pulmonary Embolism:
Samuel Z Goldhaber1, Sina Rashedi2, Mariana Pfeferman2
1Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital-Harvard Medical School, Boston, MA, USA; Thrombosis Research Group, Brigham and Women's Hospital-Harvard Medical School, Boston, MA, USA; Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Background:
Chronic thromboembolic pulmonary hypertension, a morbid complication of pulmonary embolism, is often diagnosed late due to nonspecific presentation. This quasi-cluster randomized trial evaluated whether an alert-based computerized decision support (CDS) system increases echocardiographic screening for pulmonary hypertension after pulmonary Embolism.
Methods:
Eligible participants were outpatient adults with prior pulmonary embolism who had persistent or new symptoms/signs of pulmonary hypertension or recent pulmonary testing indicating unexplained abnormalities ≥6 months after pulmonary embolism diagnosis, and no echocardiography within the prior six months. Physicians of eligible patients were randomized to receive an alert prompting further evaluation with echocardiography, or to no alert (control). The primary outcome was echocardiographic screening for pulmonary hypertension within 90 days. Additional outcomes included chronic thromboembolic pulmonary hypertension diagnosis and new pulmonary hypertension on echocardiography (tertiary outcome), defined as mean pulmonary artery pressure >20mmHg.
Results:
Seventy-three clinicians caring for 400 patients (mean age 65.1±14.2 years, female 59.0%) were assigned to alert vs. control. Echocardiography was ordered in 65 (32.5%) patients in the alert group vs. 35 (17.5%) in the control group (adjusted odds ratio [aOR] 2.23; 95% confidence interval [CI] 1.58-3.15; P=0.020). No patients had a new formal diagnosis of chronic thromboembolic pulmonary hypertension in either group. However, alert vs. control was associated with increased odds of detecting pulmonary hypertension (10.5% vs. 5.0%; aOR 2.82; 95% CI 1.74-4.58; P=0.032).
Conclusions:
The alert-based CDS was associated with nearly doubling echocardiographic screening and pulmonary hypertension detection among patients with prior pulmonary embolism at risk for chronic thromboembolic pulmonary hypertension. A larger clinical trial is needed to determine the clinical impact.
Related Concept Videos
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:29Pulmonary Embolism I: Introduction
01:19Pulmonary Embolism I: Introduction
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion, evaluates...