- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05806970
Email Nudges to Improve GDMT (MRA) Adherence in Heart Failure (ENIGMA-HF)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Importance: Guideline directed medical therapy (GDMT) is a specific set of 4 medications proven to improve morbidity and mortality for patients with heart failure (HF) with reduced ejection fraction (HFrEF), yet they are underutilized nationally and internationally. Various quality improvement (QI) interventions have had varying degrees of success at increasing GDMT prescription and titration.
Objective: The purpose of the study is to assess whether email nudges to UCLA Health cardiology clinic managers to schedule GDMT-specific appointments can lead to increased utilization of a specific medication within GDMT called a mineralocorticoid-receptor antagonist (MRA). Pertinent secondary objectives will include evaluating whether email nudges specific to MRA would increase utilization of the other medications in GDMT and whether they would increase appointments specific to GDMT.
Design, Setting, and Participants: The basic design is a pragmatic parallel-arm randomized control trial of a QI intervention. The setting is cardiology outpatient clinics at a large university-based single integrated healthcare system (UCLA Health). Participants are outpatients with HFrEF under the care of a UCLA cardiologist, with an ejection fraction on file, and currently not prescribed an MRA.
Hypothesis: The investigators hypothesize that the intervention will lead to an increased utilization of MRA, compared to the control arm.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Nicholas K Brownell, MD
- Phone Number: 310-825-9011
- Email: NBrownell@mednet.ucla.edu
Study Locations
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California
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Los Angeles, California, United States, 90095
- University of California, Los Angeles
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Contact:
- Nicholas K Brownell, MD
- Phone Number: 310-825-9011
- Email: NBrownell@mednet.ucla.edu
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Facility: UCLA Health System
- Patient is 18 years of age or older
- Patient is under the care of a UCLA cardiologist
- Patient has a primary diagnosis of HFrEF
- Patient is not currently prescribed an MRA
Exclusion Criteria:
- Hyperkalemia
- Chronic kidney disease stage 4 or higher
- Pregnant or breastfeeding patients
- Heart transplant or ventricular-assist device patients
- Hospice patients
- Patients without an LVEF on file
- Patients with an EF >35%
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Intervention - Email Nudge
The intervention will include contacting UCLA Health Cardiology clinic managers with a list of all HFrEF patients eligible for an MRA who are cared for by a provider randomized to the intervention arm.
Clinic managers will be asked to make an appointment in the next 60 days for these patients with the specific indication: GDMT initiation - consider MRA.
If an appointment is already present in the next 60 days, the indication will be changed to: GDMT initiation - consider MRA.
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An email to UCLA Health Cardiology clinic managers with a list of MRA-eligible HFrEF patients and a request to schedule or change cardiology appointments.
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No Intervention: No Intervention - Control Group
Providers randomized to the control arm will perform clinical duties as usual.
Their patients will receive routine clinical care.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage of eligible patients prescribed MRA
Time Frame: 60 days
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Proportion of patients that receive an active prescription for mineralocorticoid receptor antagonist (MRA) compared between arms at the end of the study.
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60 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage of eligible patients prescribed ACE/ARB/ARNI, beta blocker, or SGLT2i
Time Frame: 60 days
|
Proportion of patients that receive an active prescription for angiotensin-converting enzyme inhibitor (ACE), angiotensin II receptor blocker (ARB), angiotensin receptor neprilysin inhibitor (ARNI), beta blocker, or sodium-glucose cotransporter-2 inhibitor (SGLT2i) compared between arms at the end of the study.
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60 days
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Percentage of eligible patients prescribed ACE/ARB/ARNI
Time Frame: 60 days
|
Proportion of patients that receive an active prescription for angiotensin-converting enzyme inhibitor (ACE), angiotensin II receptor blocker (ARB), or angiotensin receptor neprilysin inhibitor (ARNI) compared between arms at the end of the study.
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60 days
|
Percentage of eligible patients prescribed ARNI
Time Frame: 60 days
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Proportion of patients that receive an active prescription for angiotensin receptor neprilysin inhibitor (ARNI) compared between arms at the end of the study.
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60 days
|
Percentage of eligible patients prescribed beta blocker
Time Frame: 60 days
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Proportion of patients that receive an active prescription for beta-blocker compared between arms at the end of the study.
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60 days
|
Percentage of eligible patients prescribed SGLT2i
Time Frame: 60 days
|
Proportion of patients that receive an active prescription for sodium-glucose cotransporter-2 inhibitor (SGLT2i) compared between arms at the end of the study.
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60 days
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage of eligible patients who have an appointment scheduled or indication changed in 60 days
Time Frame: 60 days
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Proportion of patients that have an appointment actively scheduled or an appointment indication actively changed within 60 days of study initiation.
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60 days
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Percentage of eligible patients who have an appointment scheduled in 60 days
Time Frame: 60 days
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Proportion of patients that have an appointment actively scheduled within 60 days of study initiation.
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60 days
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Percentage of eligible patients who have an appointment indication changed in 60 days
Time Frame: 60 days
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Proportion of patients that have an appointment already scheduled within 60 days of study initiation, but have the indication changed to "GDMT initiation - consider MRA."
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60 days
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Percentage of eligible patients who have a BMP ordered after MRA initiation
Time Frame: 60 days
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Safety endpoint: Proportion of patients that receive an active order for a basic metabolic panel (BMP) after being prescribed a mineralocorticoid receptor antagonist (MRA)
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60 days
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Collaborators and Investigators
Investigators
- Principal Investigator: Nicholas K Brownell, MD, University of California, Los Angeles
- Principal Investigator: David J Cho, MD MBA, University of California, Los Angeles
- Principal Investigator: Pooya I Bokhoor, MD, University of California, Los Angeles
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- UCLA IRB#23-000305
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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