Background – Underutilization of guideline-recommended Implantable Cardioverter Defibrillators (GR-ICD) to reduce sudden cardiac arrest (SCA) has been observed. We deployed electronic health record (EHR) notifications to doctors of patients at risk of SCA that had not yet been referred for a follow up (FU) echocardiogram (ECHO), with the hypothesis that this would result in patients newly evaluated for GR-ICD.

Methods – Patients with an echo were screened for being at risk of SCA (Fig. A). A rules-based algorithm (Fig. B) filtered patients deemed managed and needing a referral. After a minimum wait period, if a FU or cardiac intervention had not occurred or been scheduled, a notification was sent to the provider with the intention to spur a FU or referral.

Results – Out of a total 25,977 echos, 906 were flagged for at risk of SCA, and 647 already had a referral or scheduled intervention (median time to intervention / echo: 68 days / 106 days). A total of 190 alerts were sent out, and 131 met the inclusion criteria for analysis. The precision of the alert was 92%, 47 (36%) had appropriate care, (median time to intervention / echo: 47 days / 83 days) (Fig. C).

Conclusion – The implementation of an EHR-integrated notification system shows promise in closing care gaps for undermanaged patients. However, more work needs to be done to address potential social determinants of health and other underlying factors obstructing access to care (47 patients lost to FU in our analysis).

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