{"id":139930,"date":"2026-11-09T21:47:34","date_gmt":"2026-11-10T02:47:34","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=139930"},"modified":"2026-11-09T21:52:29","modified_gmt":"2026-11-10T02:52:29","slug":"better-care-hf-electronic-alerts-nearly-double-mra-prescribing-in-hfrefkey-points","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=139930","title":{"rendered":"BETTER CARE-HF: Electronic Alerts Nearly Double MRA Prescribing in HFrEF"},"content":{"rendered":"\n<p><strong>BETTER CARE-HF: Electronic Alerts Nearly Double MRA Prescribing in HFrEFKey Points:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The multicenter BETTER CARE-HF trial evaluated whether automated electronic health record (EHR) alerts could improve mineralocorticoid receptor antagonist (MRA) prescribing in patients with heart failure with reduced ejection fraction (HFrEF).<\/li>\n\n\n\n<li>Among 1,136 patients, EHR alerts significantly increased MRA prescribing compared with usual care (17.9% vs. 9.2%; RR 1.89; 95% CI, 1.35\u20132.64; <em>P<\/em>&lt;0.001).<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The intervention increased MRA prescribing by 89%, with approximately 14 patients needing to be exposed to the alert strategy to generate one additional prescription.<\/li>\n\n\n\n<li>No significant differences were observed in prescribing other guideline-directed medical therapies, hyperkalemia, or short-term hospitalizations.<\/li>\n<\/ul>\n\n\n\n<p>Despite their established mortality and hospitalization benefits, mineralocorticoid receptor antagonists (MRAs) remain substantially underprescribed in patients with heart failure with reduced ejection fraction (HFrEF). Approximately 65% to 75% of eligible patients do not receive these medications despite a Class I guideline recommendation. Electronic health record (EHR) alerts have emerged as a potential strategy to improve guideline-directed medical therapy (GDMT), although their effectiveness across different healthcare systems remains uncertain.<\/p>\n\n\n\n<p>At the American Heart Association (AHA) Scientific Sessions on November 8, 2026, Dr. Amrita Mukhopadhyay (NYU Grossman School of Medicine, NY), presented results from the multicenter BETTER CARE-HF trial, simultaneously published in <a href=\"https:\/\/doi.org\/10.1016\/j.jchf.2026.103574\"><em>JACC: Heart Failure<\/em><\/a>. Building on an earlier single-center trial demonstrating a more than twofold increase in MRA prescribing with EHR alerts, investigators evaluated whether this intervention could be successfully implemented across geographically diverse healthcare systems.<\/p>\n\n\n\n<p>The BETTER CARE-HF trial (<a href=\"https:\/\/clinicaltrials.gov\/study\/NCT06457152\">NCT06457152<\/a>) was a pragmatic, two-arm, cluster-assigned study involving 1,136 patients across 272 cardiology providers at three large U.S. health systems. Eligible patients were adults aged 18\u201389 years with an LVEF \u226440% who were not receiving MRA therapy and had no contraindications, including hypotension, hyperkalemia, or significant renal dysfunction. Patients were assigned by provider to either an automated EHR alert (n=602) or usual care (n=534).<\/p>\n\n\n\n<p>The alert appeared during outpatient cardiology visits and consolidated relevant clinical information, including LVEF, blood pressure, renal function, potassium levels, and existing GDMT, alongside a preselected MRA order set. Its selective design aimed to minimize alert fatigue while facilitating prescribing decisions. The primary endpoint was a new MRA prescription within 30 days, with secondary endpoints including prescribing of other GDMT classes, hyperkalemia, and exploratory hospitalization outcomes.<\/p>\n\n\n\n<p>The median participant age was 73 years, 70.5% were men, and the median LVEF was 33.7%. At 30 days, MRA prescribing was significantly higher in the alert group than in the usual care group (17.9% vs. 9.2%), representing an 89% relative increase (RR 1.89; 95% CI, 1.35\u20132.64; <em>P<\/em>&lt;0.001). The adjusted absolute increase was 7.6%, with approximately 14 patients needing to be exposed to the alert strategy to generate one additional MRA prescription.<\/p>\n\n\n\n<p>There were no significant differences in new prescriptions for other GDMT classes, including beta-blockers, ACE inhibitors\/ARBs\/ARNIs, or SGLT2 inhibitors. Importantly, increased MRA prescribing was not associated with higher rates of hyperkalemia (11.5% vs. 12.2%; <em>P<\/em>=0.40) or severe hyperkalemia (4.2% vs. 4.3%; <em>P<\/em> =0.80). Similarly, no significant differences were observed in all-cause hospitalization (8.1% vs. 5.8%; <em>P<\/em>=0.11) or heart failure hospitalization (1.8% vs. 1.5%; <em>P<\/em>=0.68) at 30 days.<\/p>\n\n\n\n<p>The findings suggest that targeted EHR alerts can improve prescribing of evidence-based heart failure therapies across diverse healthcare systems. By integrating real-time clinical information into existing workflows and limiting alerts to patients most likely to benefit, this approach offers a potentially scalable, low-cost strategy to address persistent gaps in GDMT implementation.<\/p>\n\n\n\n<p>However, the trial was limited to cardiology practices using Epic EHR, and its short follow-up precluded assessment of long-term clinical outcomes. Furthermore, medication dispensing and adherence were not evaluated. Future studies will be needed to determine whether sustained improvements in prescribing translate into reductions in heart failure hospitalizations and mortality.<\/p>\n\n\n\n<p>The study was supported by the National Institutes of Health\/National Center for Advancing Translational Sciences, with additional support from the NYU Langone Health Learning Health System program and institutional contributions.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>BETTER CARE-HF: Electronic Alerts Nearly Double MRA Prescribing in HFrEFKey Points: Despite their established mortality and hospitalization benefits, mineralocorticoid receptor antagonists (MRAs) remain substantially underprescribed in patients with heart failure with reduced ejection fraction (HFrEF). Approximately 65% to 75% of eligible patients do not receive these medications despite a Class I guideline recommendation. Electronic health [&hellip;]<\/p>\n","protected":false},"author":40615,"featured_media":139932,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"aside","meta":{"footnotes":"","_ppma_block_editor_authors":""},"categories":[1093],"tags":[1094,47,185],"tmauthors":[1095],"ppma_author":[1069],"class_list":{"0":"post-139930","1":"post","2":"type-post","3":"status-publish","4":"format-aside","5":"has-post-thumbnail","7":"category-aha-2026","8":"tag-aha2026","9":"tag-featured","10":"tag-news","11":"post_format-post-format-aside","12":"author-hassan-adam-alhassan-md"},"authors":[{"term_id":1069,"user_id":40615,"is_guest":0,"slug":"hassan-adam-alhassan-md","display_name":"Hassan Adam Alhassan MD","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/8cc8318e58bf0ad1548b042cbb04e2e62466d8fe5780d7b1f138246f2c21b2b5?s=96&r=g","avatar_alt":"","avatar_decorative":"","author_category":"1","first_name":"Hassan","last_name":"Adam Alhassan","user_url":"","job_title":"Clinical Fellow Electrophysiology BIDMC","description":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/139930","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40615"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=139930"}],"version-history":[{"count":2,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/139930\/revisions"}],"predecessor-version":[{"id":139934,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/139930\/revisions\/139934"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/139932"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=139930"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=139930"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=139930"},{"taxonomy":"tmauthors","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftmauthors&post=139930"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=139930"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}