The impact of a transition of care electronic medication titration plan on optimising the treatment of heart failure after hospital discharge

Abstract Background Previous studies using paper‐based medication titration plans in patients with heart failure with reduced ejection fraction (HFrEF) have shown improvement in the up‐titration of heart failure (HF) medications after acute care. Aim In an era of digital health, this study aimed to evaluate the impact of an individualised electronic HF transition of care medication titration plan (eHF‐TP) embedded in the electronic medical record (EMR) discharge summary given to general practitioners (GPs) post‐discharge from hospital. The up‐titration of HFrEF medications and hospital readmissions for HF after hospital discharge at a multi‐site, tertiary hospital in Melbourne, Australia, was assessed. Method The eHF‐TP was established in May 2021. The frequency of hospital readmissions and up‐titration of medications within 1‐ and‐6 months after discharge were compared in participants with HFrEF discharged before and after eHF‐TP implementation. Ethical approval was granted by the Monash Health Human Research Ethics Committee (Reference no: 72351) and the study conforms to the Australian National statement on ethical conduct in human research . Informed consent was obtained from all participants via distribution of project information sheets indicating their participation was voluntary, anonymous, and they could withdraw their consent at any time, verbal consent was obtained and documented in the electronic medical records. Results There were 98 and 96 participants were in the comparator (before eHF‐TP implementation) and intervention (after eHF‐TP implementation) groups respectively. Within 1 month after discharge, 8/96 (8.3%) participants in the intervention versus 3/98 (3.1%) in the comparator group had their medications up‐titrated (p = 0.11). Within 6 months, 12/96 (12.5%) participants in the intervention versus 6/98 (6.1%) in the comparator group had their medications up‐titrated (p = 0.13). The frequency of hospital readmissions for HF was 3/96 (3.1%) in the intervention versus 4/98 (4.1%) (p = 1) in the comparator group at 1 month, and 7/96 (7.3%) in the intervention versus 8/98 (8.2%) (p = 0.82) in the comparator group at 6 months. Conclusion Although not reaching statistical significance in our study, the use of individualised eHF‐TPs may still have a role in improving the up‐titration of HFrEF medications following hospital discharge.