title: Clinical reminders to providers of patients with reduced left ventricular ejection fraction increase defibrillator referral: a randomized trial.
abstract: BACKGROUND
  Many patients who are candidates for implantable cardioverter defibrillators (ICDs) are not referred for potential implantation. We sought to determine if a simple provider reminder would increase referrals.
  
  
  RESULTS
  We identified consecutive patients from January 2007 through July 2010 in the VA Palo Alto Health Care System with a left ventricular ejection fraction<35% on echocardiography. Patients were excluded using available administrative data only (no chart review) if they were known to have an ICD, if they were ≥80 years old, or if they did not have a current primary care or cardiology provider within the system. We randomized patients to no intervention or a clinical note to the provider in the medical record. The outcomes were referral for consideration of defibrillator implantation (primary) and documented discussion (secondary). Of 330 patients with left ventricular ejection fraction≤35%, 128 were known to have an ICD, 85 were no longer followed in the healthcare system, and 28 were ≥80 years old, leaving 89 patients to be randomized. Forty-six patients were randomized to intervention and 43 to control. Eleven of 46 (24%) intervention patients were referred for consideration of ICD implantation during the following 6 months versus 1 of 43 (2%) control patients (P=0.004). Overall, 31 of 46 (67%) intervention patients versus 19 of 43 (44%) control patients had documentation discussing potential candidacy for defibrillators (P=0.05).
  
  
  CONCLUSIONS
  In patients with low left ventricular ejection fraction, a simple electronic medical record-based intervention directed to their providers improved the rates of referral for ICD implantation.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01217827.
authors: Medical Service, VA Palo Alto Health Care System, Palo Alto, CA.
authors: Anurag
authors: A
authors: Gupta
authors: Parisa
authors: P
authors: Gholami
authors: Mintu P
authors: MP
authors: Turakhia
authors: Karen
authors: K
authors: Friday
authors: Paul A
authors: PA
authors: Heidenreich
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004452:Echocardiography; D005260:Female; D019983:Guideline Adherence; D006282:Health Personnel; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D018579:Patient Selection; D012017:Referral and Consultation; D017010:Reminder Systems / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*
keywords: death, sudden, cardiac; defibrillators; guideline adherence; randomized controlled trial; reminder systems