Impact of clinical pathways on enhancing compliance with evidence-based therapies for Heart failure with reduced ejection fraction–A retrospective cohort study

Naga Sasidhar Kanaparthy, Stephen Possick, Wei Teng, Christopher Maulion and Nancy Kim

PLOS ONE, 2025, vol. 20, issue 9, 1-12

Abstract: Background: Heart failure (HF) mortality is rising despite robust evidence-based guidelines. Hospitalization presents an opportune time to optimize care. Inpatient care pathways (CP) embedded in the electronic health record (EHR) can enhance adherence to guidelines by providing real-time decision support. Objective: To measure the impact of the heart failure reduced ejection fraction (HFrEF) CP on early diuretic use, goal-directed medical therapy (GDMT), and referral to comprehensive HF management (CHFM) on discharge. Methods: A HFrEF CP embedded into the EHR was built by multidisciplinary providers across a large academic medical center. Providers could place orders and document notes directly from the pathway. We conducted a retrospective cohort study of all the HF hospitalizations two years after pathway implementation and further limited the cohort to those with ejection fraction (EF) ≤ 40%. We compared rates of early diuretic use, GDMT, and referral to CHFM between cohorts defined by pathway use. Results: 1,639 patients contributed 2,062 hospitalizations. The pathway was opened in 362 (17.6%) hospitalizations. There were no significant clinical or sociodemographic differences between groups. Bivariate analyses revealed more GDMT (χ2 (1) = 3.651, p = 0.056); while multivariable analysis showed more early diuretics (OR = 1.58, 95% CI 1.19, 2.09, p = 0.002) and referrals to CHFM (OR = 3.24, 95% CI 2.54, 4.12, p

Date: 2025
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0330188

DOI: 10.1371/journal.pone.0330188

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