Impact of a clinical decision support system on adherence to clinical guidelines in the management of patients with heart failure (SPHERA-HF study)
S. N. Tereshchenko,
I. V. Zhirov,
A. M. Shangina,
F. N. Paleev,
S. A. Boytsov,
A. E. Uranov,
K. S. Astrakova,
I. L. Mikheenko,
A. A. Gartung,
A. A. Spiridonov,
Y. S. Krivosheev,
I. I. Shestova,
D. S. Markov,
I. L. Strokolskaya,
O. L. Barbarash,
M. A. Meshkova,
I. A. Starodubtseva,
N. A. Gurina,
V. A. Petrakovskaia https://doi.org/10.15829/1728-8800-2025-4462
EDN: ZSMLDI
Abstract
Aim. To assess the impact of a clinical decision support system (CDSS) aimed at increasing physician compliance with clinical guidelines on heart failure (HF) in real-world practice in order to improve the effectiveness of managing this category of patients and clinical outcomes in pilot Russian regions.
Material and methods. As part of the retrospective multicenter study SPHERA-HF, data of electronic health records from 49 medical facilities in three Russia regions were analyzed. The study participants were divided into inpatient and outpatient cohorts. The main inclusion criterion was a history of HF diagnosis. The features of patient management in real-world practice were studied before and after the implementation of the CDSS.
Results. The study included 66166 patients. After CDSS imple neprilysin inhibitors in patients with HF with reduced ejection fraction increased in the in-hospital cohort from 32,9% to 52,3% (p<0,05); in the outpatient cohort from 24,2% to 45,3% (p<0,05). There was an increase in the prescription rate of quadruple therapy at discharge in the inhospital cohort from 22,3% to 32,6% (p<0,05); at the initiation visit in the outpatient cohort from 24,6% to 42,9% (p<0,05). There was a decrease in the number of rehospitalizations for cardiovascular diseases in the inhospital cohort from 26,9% to 20,1% (p<0,05).
Conclusion. The study results indicate a positive impact of CDSS introduction on managing patients with HF.
Keywords
heart failure,
clinical decision support system,
brain natriuretic peptide,
N-terminal pro-brain natriuretic peptide,
left ventricular ejection fraction,
angiotensin receptor-neprilysin inhibitors,
quadruple therapy,
recommended disease-modifying therapy,
real-world practice
Supporting agencies: The article was prepared with financial support from Novartis Pharma LLC.
About the Authors
S. N. Tereshchenko
Chazov National Medical Research Center of Cardiology
Russian Federation
Russian Federation
Moscow
I. V. Zhirov
Chazov National Medical Research Center of Cardiology; Chazov National Medical Research Center of Cardiology
Russian Federation
Russian Federation
Moscow
A. M. Shangina
Chazov National Medical Research Center of Cardiology
Russian Federation
Russian Federation
Moscow
F. N. Paleev
Chazov National Medical Research Center of Cardiology
Russian Federation
Russian Federation
Moscow
S. A. Boytsov
Chazov National Medical Research Center of Cardiology
Russian Federation
Russian Federation
Moscow
A. E. Uranov
Scientific Group OOO "MedicBook"
Russian Federation
Russian Federation
Novosibirsk
K. S. Astrakova
Scientific Group OOO "MedicBook"
Russian Federation
Russian Federation
Novosibirsk
I. L. Mikheenko
Scientific Group OOO "MedicBook"
Russian Federation
Russian Federation
Novosibirsk
A. A. Gartung
Scientific Group OOO "MedicBook"
Russian Federation
Russian Federation
Novosibirsk
A. A. Spiridonov
Scientific Group OOO "MedicBook"
Russian Federation
Russian Federation
Novosibirsk
Y. S. Krivosheev
Regional Clinical Cardiology Dispensary
Russian Federation
Russian Federation
Stavropol
I. I. Shestova
Tula Regional Clinical Cardiology Dispensary
Russian Federation
Russian Federation
Tula
D. S. Markov
Government of the Tula Oblast
Russian Federation
Russian Federation
Tula
I. L. Strokolskaya
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Russian Federation
Kemerovo
O. L. Barbarash
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation
Russian Federation
Kemerovo
M. A. Meshkova
Lipetsk Regional Clinical Hospital
Russian Federation
Russian Federation
Lipetsk
I. A. Starodubtseva
Burdenko Voronezh State Medical University
Russian Federation
Russian Federation
Voronezh
N. A. Gurina
OOO Novartis Pharma
Russian Federation
Russian Federation
Moscow
V. A. Petrakovskaia
OOO Novartis Pharma
Russian Federation
Russian Federation
Moscow
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Supplementary files
What is already known about the subject?
- Cardiovascular diseases occupy the first place in mortality structure. Heart failure (HF) is the final stage of cardiovascular disease continuum.
- In real-world practice, not all patients undergo the necessary diagnostic examinations in full, and the recommended disease-modifying therapy is not always prescribed.
What might this study add?
- The introduction of clinical decision support system (CDSS) contributed to a significant increase in the frequency of necessary examinations in patients with HF, including the determination of brain natriuretic peptide and left ventricular ejection fraction (EF).
- After CDSS introduction, there was an increase in prescription rate of angiotensin receptor-neprilysin inhibitors, quadruple therapy in patients with heart failure with reduced and mildly reduced EF.
- A decrease in rehospitalization rate was observed among patients with HF who had previously been hospitalized for any cardiac diagnosis.
Review
For citations:
Tereshchenko S.N., Zhirov I.V., Shangina A.M., Paleev F.N., Boytsov S.A., Uranov A.E., Astrakova K.S., Mikheenko I.L., Gartung A.A., Spiridonov A.A., Krivosheev Y.S., Shestova I.I., Markov D.S., Strokolskaya I.L., Barbarash O.L., Meshkova M.A., Starodubtseva I.A., Gurina N.A., Petrakovskaia V.A. Impact of a clinical decision support system on adherence to clinical guidelines in the management of patients with heart failure (SPHERA-HF study). Cardiovascular Therapy and Prevention. 2025;24(7):4462. (In Russ.) https://doi.org/10.15829/1728-8800-2025-4462. EDN: ZSMLDI
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