Optimizing In-hospital Use of Evidence-based Therapies for Patients With Cardio-Renal-Metabolic Disease

Duke University202 enrolled

Overview

This study will be a prospective randomized implementation trial for patients hospitalized with heart failure, chronic kidney disease, and/or type 2 diabetes mellitus within Duke University Medical Center. The primary hypothesis is that a virtual quality improvement-based consult intervention will improve the rate of in-hospital evidence-based cardio-renal-metabolic medication use, particularly SGLT2 inhibitor therapy. Approximately 200 patients meeting eligibility criteria will be included in the study. Patients will be assigned into study groups, as defined by randomization of their treating clinician team to receiving the virtual consult versus not.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

202

Conditions

Heart Failure Type 2 Diabetes Chronic Kidney Diseases

Interventions

Virtual Consult InterventionOTHER

The intervention will consist of a quality improvement (QI)-based virtual consult designed by a multi-disciplinary team that will aim to address provider-level, patient-level, and system-level barriers to cardio-renal-metabolic disease medications

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1\. Hospitalized adults age ≥ 18 years with ≥1 of the following diagnoses, as defined by the medical record: 1. HF (any ejection fraction) 2. CKD with estimated GFR ≥ 20 mL/min/1.73m2 \* 3. T2DM (by clinical history or hemoglobin A1c) Exclusion Criteria: 1. End-stage stage renal disease on dialysis or eGFR \<20 mL/kg/1.73m2. 2. Pre-menopausal woman who are either breast-feeding or pregnant 3. History of heart transplant or actively listed for heart transplant 4. Implanted left ventricular assist device or implant anticipated within 3 months. 5. Enrolled in or planning to enroll in hospice care. 6. Active cancer (except localized prostate, breast, or non-melanoma skin cancers)

Outcomes

Primary Outcomes

Proportion of patients prescribed SGLT2i (sodium glucose co-transporter-2 inhibitors)

Time frame: hospital discharge (up to approximately 14 days)