Your Heart Failure Patient Was Discharged Yesterday. Did They Get the Right Medications?
It's a question that gets asked too rarely and a new letter to the editor in the Internal Medicine Journal argues we need to do better.
The piece focuses on guideline-directed medical therapy (GDMT) for heart failure and atrial fibrillation — the evidence-based medications we know reduce hospitalisations, strokes, and deaths. The problem? Huge numbers of eligible patients are discharged without these medications being started or properly adjusted. And the downstream costs, both human and financial, are significant.
The authors point to some genuinely compelling trial evidence. In the PROMPT-HF trial, a simple electronic alert to clinicians increased the rate of patients receiving additional heart failure therapy within 30 days. In BETTER CARE-HF, in-encounter alerts more than doubled prescribing of a key heart failure medication compared to standard care. And in the mAFA II trial for atrial fibrillation, a pathway app with real-time risk scoring and prompts cut the combined rate of stroke, death and rehospitalisation by more than half.
The frustrating part? Despite this evidence, uptake of automated prompts in Australian healthcare remains patchy at best. Different hospitals run different digital systems, funding is inconsistent, and what works in one centre often can't be transplanted to another without rebuilding from scratch.
The authors call for a shared national library of evidence-based clinical prompts, embedded within proper care pathways — not just bolted on as standalone pop-ups that get clicked away. They're also clear that alerts alone aren't the answer; without the right infrastructure around them, they risk adding to already strained clinician workloads.