Abstract：
UNASSIGNED: Despite atrial fibrillation guideline recommendations, many patients with heart failure with reduced ejection fraction (EF) continue to receive IV diltiazem for acute rate control.
UNASSIGNED: Our institution recently implemented a clinical decision support system (CDSS)-based tool that recommends against the use of diltiazem in patients with an EF ≤ 40%. The objective of this study was to evaluate outcomes of adherence to the aforementioned CDSS-based tool.
UNASSIGNED: This multi-hospital, retrospective study assessed patients who triggered the CDSS alert and compared those who did and did not discontinue diltiazem. The primary outcome was the occurrence of clinical deterioration. The primary endpoint was compared utilizing a Fisher\'s Exact Test, and a multivariate logistic regression model was developed to confirm the results of the primary analysis.
UNASSIGNED: A total of 246 patients were included in this study with 146 patients in the nonadherent group (received diltiazem) and 100 patients in the adherent group (did not receive diltiazem). There was a higher proportion of patients experiencing clinical deterioration in the alert nonadherence group (33% vs 21%, P = 0.044), including increased utilization of inotropes and vasopressors, and higher rate of transfer to ICU.
UNASSIGNED: In patients with heart failure with reduced EF, diltiazem use after nonadherence to a CDSS alert resulted in an increased risk of clinical deterioration. This study highlights the need for improved provider adherence to diltiazem clinical decision support systems.
UNASSIGNED: Our institution recently implemented a clinical decision support system (CDSS)-based tool that recommends against the use of diltiazem in patients with an EF ≤ 40%. The objective of this study was to evaluate outcomes of adherence to the aforementioned CDSS-based tool.
UNASSIGNED: This multi-hospital, retrospective study assessed patients who triggered the CDSS alert and compared those who did and did not discontinue diltiazem. The primary outcome was the occurrence of clinical deterioration. The primary endpoint was compared utilizing a Fisher\'s Exact Test, and a multivariate logistic regression model was developed to confirm the results of the primary analysis.
UNASSIGNED: A total of 246 patients were included in this study with 146 patients in the nonadherent group (received diltiazem) and 100 patients in the adherent group (did not receive diltiazem). There was a higher proportion of patients experiencing clinical deterioration in the alert nonadherence group (33% vs 21%, P = 0.044), including increased utilization of inotropes and vasopressors, and higher rate of transfer to ICU.
UNASSIGNED: In patients with heart failure with reduced EF, diltiazem use after nonadherence to a CDSS alert resulted in an increased risk of clinical deterioration. This study highlights the need for improved provider adherence to diltiazem clinical decision support systems.
摘要：
■尽管有房颤指南建议，许多射血分数（EF）降低的心力衰竭患者继续接受静脉地尔硫卓进行急性心率控制。
■我们的机构最近实施了一种基于临床决策支持系统（CDSS）的工具，该工具建议不要在EF≤40％的患者中使用地尔硫卓。这项研究的目的是评估对上述基于CDSS的工具的依从性的结果。
■这家多家医院，回顾性研究评估了触发CDSS警报的患者,并比较了那些触发和未停用地尔硫卓的患者.主要结果是临床恶化的发生。使用Fisher精确检验比较主要终点，并建立了多变量逻辑回归模型来证实主要分析的结果。
■本研究共纳入246例患者，其中146例患者为非粘附组（接受地尔硫卓），100例患者为粘附组（未接受地尔硫卓）。在戒备不依从组中出现临床恶化的患者比例较高(33%vs21%,P=0.044),包括增加使用肌力药和血管加压药，和更高的转院率ICU。
■在EF降低的心力衰竭患者中，不遵守CDSS警报后使用地尔硫导致临床恶化的风险增加.这项研究强调了需要提高提供者对地尔硫卓临床决策支持系统的依从性。
■我们的机构最近实施了一种基于临床决策支持系统（CDSS）的工具，该工具建议不要在EF≤40％的患者中使用地尔硫卓。这项研究的目的是评估对上述基于CDSS的工具的依从性的结果。
■这家多家医院，回顾性研究评估了触发CDSS警报的患者,并比较了那些触发和未停用地尔硫卓的患者.主要结果是临床恶化的发生。使用Fisher精确检验比较主要终点，并建立了多变量逻辑回归模型来证实主要分析的结果。
■本研究共纳入246例患者，其中146例患者为非粘附组（接受地尔硫卓），100例患者为粘附组（未接受地尔硫卓）。在戒备不依从组中出现临床恶化的患者比例较高(33%vs21%,P=0.044),包括增加使用肌力药和血管加压药，和更高的转院率ICU。
■在EF降低的心力衰竭患者中，不遵守CDSS警报后使用地尔硫导致临床恶化的风险增加.这项研究强调了需要提高提供者对地尔硫卓临床决策支持系统的依从性。
