Facilitators, barriers, and insights using an HFA-PEFF-based clinical decision support system: A proof-of-concept study

Abstract

Background and aims

Knowing that heart failure (HF) with preserved ejection fraction (HFpEF) can be difficult to diagnose, a clinical decision support system (CDSS), with functional, morphological and biomarker domains, was built. Therefore, this research aimed to analyse the possibility of implementing CDSS, compliance of the physicians with the CDSS recommendations, as well as identify obstacles and facilitators to its usage.

Methods

This mixed-methods study was conducted over a 1 year period at the Institute of Cardiovascular Diseases of Vojvodina (Sremska Kamenica, Serbia). The retrospective component included an analysis of patients who had symptoms and/or signs of HF, with an ejection fraction (EF) of ≥50%. The Heart Failure Association pre-test assessment, echocardiography and natriuretic peptide, functional testing, final aetiology (HFA-PEFF) score was used to build a CDSS and to calculate the probability scores for these patients. The prospective component involved an electronic survey that was used to gain feedback from physicians about the CDSS.

Results

The sample included 225 patients, out of which 194 (86.2%) had the HFA-PEFF score of 5–6, suggesting probable HFpEF. This syndrome was clinically documented in the discharge report in only 32 (16.5%) of these patients. The response rate of the survey was 83.3%, including physicians at different levels of education. Barriers to CDSS usage included a lack of echocardiographic skills and knowledge about phenotype profiling in HFpEF patients. An increase in explainability and transparency, as well as staff education, were mentioned as the main facilitators.

Conclusions

The CDSS demonstrated reasonable effectiveness in diagnosing and classifying patients with symptoms of HF if the measured EF was ≥50%. The conducted survey highlighted that physician education, in both CDSS- and HFpEF-related domains, is a key factor in the battle against HFpEF.