{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T02:31:50Z","timestamp":1792031510986,"version":"4.4.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2021,2,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Major gaps exist in the routine initiation and dose up-titration of guideline-directed medical therapies (GDMT) for patients with heart failure with reduced ejection fraction. Without novel approaches to improve prescribing, the cumulative benefits of heart failure with reduced ejection fraction treatment will be largely unrealized. Direct-to-consumer marketing and shared decision making reflect a culture where patients are increasingly involved in treatment choices, creating opportunities for prescribing interventions that engage patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The EPIC-HF (Electronically Delivered, Patient-Activation Tool for Intensification of Medications for Chronic Heart Failure with Reduced Ejection Fraction) trial randomized patients with heart failure with reduced ejection fraction from a diverse health system to usual care versus patient activation tools\u2014a 3-minute video and 1-page checklist\u2014delivered electronically 1 week before, 3 days before, and 24 hours before a cardiology clinic visit. The tools encouraged patients to work collaboratively with their clinicians to \u201cmake one positive change\u201d in heart failure with reduced ejection fraction prescribing. The primary endpoint was the percentage of patients with GDMT medication initiations and dose intensifications from immediately preceding the cardiology clinic visit to 30 days after, compared with usual care during the same period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      EPIC-HF enrolled 306 patients, 290 of whom attended a clinic visit during the study period: 145 were sent the patient activation tools and 145 were controls. The median age of patients was 65 years; 29% were female, 11% were Black, 7% were Hispanic, and the median ejection fraction was 32%. Preclinic data revealed significant GDMT opportunities, with no patients on target doses of \u03b2-blocker, sacubitril\/valsartan, and mineralocorticoid receptor antagonists. From immediately preceding the cardiology clinic visit to 30 days after, 49.0% in the intervention and 29.7% in the control experienced an initiation or intensification of their GDMT (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.001). The majority of these changes were made at the clinician encounter itself and involved dose uptitrations. There were no deaths and no significant differences in hospitalization or emergency department visits at 30 days between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A patient activation tool delivered electronically before a cardiology clinic visit improved clinician intensification of GDMT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03334188.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.120.051863","type":"journal-article","created":{"date-parts":[[2020,11,17]],"date-time":"2020-11-17T13:06:24Z","timestamp":1605618384000},"page":"427-437","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":166,"title":["An Electronically Delivered Patient-Activation Tool for Intensification of Medications for Chronic Heart Failure With Reduced Ejection Fraction"],"prefix":"10.1161","volume":"143","clinical-trial-number":[{"clinical-trial-number":"nct03334188","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2540-3095","authenticated-orcid":true,"given":"Larry A.","family":"Allen","sequence":"first","affiliation":[{"name":"University of Colorado School of Medicine, Aurora (L.A.A., G.V., C.K.M., C.E.K., L.J.H., P.K., P.N.P., K.P., G.H., J.S.T., K.E.T., D.P.K., D.J.M., P.M.B., D.D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6672-3063","authenticated-orcid":true,"given":"Grace","family":"Venechuk","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora (L.A.A., G.V., C.K.M., C.E.K., L.J.H., P.K., P.N.P., K.P., G.H., J.S.T., K.E.T., D.P.K., D.J.M., P.M.B., D.D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2131-9910","authenticated-orcid":true,"given":"Colleen K.","family":"McIlvennan","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora (L.A.A., G.V., C.K.M., C.E.K., L.J.H., P.K., P.N.P., K.P., G.H., J.S.T., K.E.T., D.P.K., D.J.M., P.M.B., D.D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"II","given":"Robert L.","family":"Page","sequence":"additional","affiliation":[{"name":"University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (R.L.P., K.E.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3521-7157","authenticated-orcid":true,"given":"Christopher E.","family":"Knoepke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura J.","family":"Helmkamp","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora (L.A.A., G.V., C.K.M., C.E.K., L.J.H., P.K., P.N.P., K.P., G.H., J.S.T., K.E.T., D.P.K., D.J.M., P.M.B., D.D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prateeti","family":"Khazanie","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora (L.A.A., G.V., C.K.M., C.E.K., L.J.H., P.K., P.N.P., K.P., G.H., J.S.T., K.E.T., D.P.K., D.J.M., P.M.B., D.D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6864-2016","authenticated-orcid":true,"given":"Pamela N.","family":"Peterson","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora (L.A.A., G.V., C.K.M., C.E.K., L.J.H., P.K., P.N.P., K.P., G.H., J.S.T., K.E.T., D.P.K., D.J.M., P.M.B., D.D.M.)."},{"name":"Denver Health Medical Center, CO (P.N.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Pierce","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora (L.A.A., G.V., C.K.M., C.E.K., L.J.H., P.K., P.N.P., K.P., G.H., J.S.T., K.E.T., D.P.K., D.J.M., P.M.B., D.D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey","family":"Harger","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora (L.A.A., G.V., C.K.M., C.E.K., L.J.H., P.K., P.N.P., K.P., G.H., J.S.T., K.E.T., D.P.K., D.J.M., P.M.B., D.D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2437-1477","authenticated-orcid":true,"given":"Jocelyn S.","family":"Thompson","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora (L.A.A., G.V., C.K.M., C.E.K., L.J.H., P.K., P.N.P., K.P., G.H., J.S.T., K.E.T., D.P.K., D.J.M., P.M.B., D.D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tristan J.","family":"Dow","sequence":"additional","affiliation":[{"name":"University of Colorado Health Poudre Valley Hospital, Loveland (T.J.D., L.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lance","family":"Richards","sequence":"additional","affiliation":[{"name":"University of Colorado Health Poudre Valley Hospital, Loveland (T.J.D., L.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janice","family":"Huang","sequence":"additional","affiliation":[{"name":"University of Colorado Health Memorial Hospital, Colorado Springs (J.H., J.R.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James R.","family":"Strader","sequence":"additional","affiliation":[{"name":"University of Colorado Health Memorial Hospital, Colorado Springs (J.H., J.R.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2041-7404","authenticated-orcid":true,"given":"Katy E.","family":"Trinkley","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora (L.A.A., G.V., C.K.M., C.E.K., L.J.H., P.K., P.N.P., K.P., G.H., J.S.T., K.E.T., D.P.K., D.J.M., P.M.B., D.D.M.)."},{"name":"University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (R.L.P., K.E.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2832-9348","authenticated-orcid":true,"given":"David P.","family":"Kao","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora (L.A.A., G.V., C.K.M., C.E.K., L.J.H., P.K., P.N.P., K.P., G.H., J.S.T., K.E.T., D.P.K., D.J.M., P.M.B., D.D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Magid","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora (L.A.A., G.V., C.K.M., C.E.K., L.J.H., P.K., P.N.P., K.P., G.H., J.S.T., K.E.T., D.P.K., D.J.M., P.M.B., D.D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter M.","family":"Buttrick","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora (L.A.A., G.V., C.K.M., C.E.K., L.J.H., P.K., P.N.P., K.P., G.H., J.S.T., K.E.T., D.P.K., D.J.M., P.M.B., D.D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9597-9642","authenticated-orcid":true,"given":"Daniel D.","family":"Matlock","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora (L.A.A., G.V., C.K.M., C.E.K., L.J.H., P.K., P.N.P., K.P., G.H., J.S.T., K.E.T., D.P.K., D.J.M., P.M.B., D.D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31829e8776"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000509"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.11.025"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw128"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.04.070"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2018.10.010"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcma.2017.04.011"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30306-1"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2020.04.019"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000070952.08969.5B"},{"key":"e_1_3_3_12_2","first-page":"773","article-title":"Analysis of a failed clinical decision support system for management of congestive heart failure.","author":"Wadhwa R","year":"2008","unstructured":"Wadhwa, R, Fridsma, DB, Saul, MI, Penrod, LE, Visweswaran, S, Cooper, GF, Chapman, W. Analysis of a failed clinical decision support system for management of congestive heart failure. AMIA Annu Symp Proc. 2008773\u2013777.","journal-title":"AMIA Annu Symp Proc"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/1062860613509265"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.1999.01049.x"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.2753\/JOA0091-3367360311"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.w4.219"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1109283"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001431.pub5"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2020.08.013"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.113.000289"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.014281"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-018-0808-2"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.010635"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1362"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.0315"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.19271"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f657"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2019.103956"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.3757"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.0640"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.2822"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1911303"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2022190"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1915928"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2019.12.001"},{"key":"e_1_3_3_36_2","unstructured":"National Priorities for Research and Research Agenda. Patient-Centered Research Institute; 2014. Accessed October 28 2020. https:\/\/www.pcori.org\/sites\/default\/files\/PCORI-National-Priorities-and-Research-Agenda.pdf."},{"key":"e_1_3_3_37_2","unstructured":"Decision Memo for Implantable Cardioverter Defibrillators (CAG-00157R4) 2018. Accessed October 28 2020 https:\/\/www.cms.gov\/medicare-coverage-database\/details\/nca-decision-memo.aspx?NCAId=288"},{"key":"e_1_3_3_38_2","unstructured":"Decision Memo for Percutaneous Left Atrial Appendage (LAA) Closure Therapy (CAG-00445N) 2016. Accessed October 28 2020. https:\/\/www.cms.gov\/medicare-coverage-database\/details\/nca-decision-memo.aspx?NCAId=281"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.0790"},{"key":"e_1_3_3_40_2","unstructured":"Anderson M. Mobile Technology and Home Broadband 2019. Pew Research Center; 2019. Accessed October 28 2020. https:\/\/www.pewresearch.org\/internet\/2019\/06\/13\/mobile-technology-and-home-broadband-2019\/"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.120.051863","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T09:01:38Z","timestamp":1749027698000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.120.051863"}},"subtitle":["The EPIC-HF Trial"],"short-title":[],"issued":{"date-parts":[[2021,2,2]]},"references-count":39,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,2,2]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.120.051863"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.120.051863","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,2]]},"assertion":[{"value":"2020-10-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}