PURPOSE: The purpose of this study is to describe the results of manual and automatic electronic medical record-based screening of patients at risk of sudden cardiac arrest (SCA) based on measurements of left ventricular ejection fraction (LVEF). METHODS: Counseling regarding SCA risk and implantable cardioverter defibrillator (ICD) therapy is underutilized in patients with reduced LVEF. We developed and implemented an electronic medical record (EMR)-based system for screening of such patients to improve care. In phase one, manual screening of electronic records and LVEF databases was initially performed by trained cardiac device nurses. In phase two, records were screened automatically by a customized program, and candidate patient records were sent to cardiac device nurses for final review and disposition. RESULTS: In phase one, 2,531 patients with LVEF ≤35% were identified over 398 days. Manual EMR review showed that 1,918 patients (76%) received appropriate counseling regarding SCA risk, received ICDs, or had disqualifying comorbidities. In phase two, 1,081 patients with LVEF ≤35% were identified after automatic screening of 44,672 echocardiograms and EMR over 251 days. Of these, 513 patients (58%) received appropriate counseling regarding SCA risk, received ICDs, or had disqualifying comorbidities. CONCLUSIONS: These data detail the utilization of consultation regarding SCA risk and ICDs in patients with reduced LVEF at a tertiary care center with ready access to arrhythmia specialists. Notification of primary providers of reduced LVEF with recommendation for consultation was not effective in improving patient care.
PURPOSE: The purpose of this study is to describe the results of manual and automatic electronic medical record-based screening of patients at risk of sudden cardiac arrest (SCA) based on measurements of left ventricular ejection fraction (LVEF). METHODS: Counseling regarding SCA risk and implantable cardioverter defibrillator (ICD) therapy is underutilized in patients with reduced LVEF. We developed and implemented an electronic medical record (EMR)-based system for screening of such patients to improve care. In phase one, manual screening of electronic records and LVEF databases was initially performed by trained cardiac device nurses. In phase two, records were screened automatically by a customized program, and candidate patient records were sent to cardiac device nurses for final review and disposition. RESULTS: In phase one, 2,531 patients with LVEF ≤35% were identified over 398 days. Manual EMR review showed that 1,918 patients (76%) received appropriate counseling regarding SCA risk, received ICDs, or had disqualifying comorbidities. In phase two, 1,081 patients with LVEF ≤35% were identified after automatic screening of 44,672 echocardiograms and EMR over 251 days. Of these, 513 patients (58%) received appropriate counseling regarding SCA risk, received ICDs, or had disqualifying comorbidities. CONCLUSIONS: These data detail the utilization of consultation regarding SCA risk and ICDs in patients with reduced LVEF at a tertiary care center with ready access to arrhythmia specialists. Notification of primary providers of reduced LVEF with recommendation for consultation was not effective in improving patient care.
Authors: J M Grimshaw; R E Thomas; G MacLennan; C Fraser; C R Ramsay; L Vale; P Whitty; M P Eccles; L Matowe; L Shirran; M Wensing; R Dijkstra; C Donaldson Journal: Health Technol Assess Date: 2004-02 Impact factor: 4.014
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Authors: Arthur J Moss; Wojciech Zareba; W Jackson Hall; Helmut Klein; David J Wilber; David S Cannom; James P Daubert; Steven L Higgins; Mary W Brown; Mark L Andrews Journal: N Engl J Med Date: 2002-03-19 Impact factor: 91.245
Authors: Bimal Shah; Adrian F Hernandez; Li Liang; Sana M Al-Khatib; Clyde W Yancy; Gregg C Fonarow; Eric D Peterson Journal: J Am Coll Cardiol Date: 2009-02-03 Impact factor: 24.094
Authors: Adrian F Hernandez; Gregg C Fonarow; Li Liang; Sana M Al-Khatib; Lesley H Curtis; Kenneth A LaBresh; Clyde W Yancy; Nancy M Albert; Eric D Peterson Journal: JAMA Date: 2007-10-03 Impact factor: 56.272
Authors: Sana M Al-Khatib; Gillian D Sanders; Mark Carlson; Aida Cicic; Anne Curtis; Gregg C Fonarow; Peter W Groeneveld; David Hayes; Paul Heidenreich; Daniel Mark; Eric Peterson; Eric N Prystowsky; Philip Sager; Marcel E Salive; Kevin Thomas; Clyde W Yancy; Wojciech Zareba; Douglas Zipes Journal: Am Heart J Date: 2008-07-26 Impact factor: 4.749