Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jul;30(4):771-776.
doi: 10.1007/s10741-025-10503-4. Epub 2025 Mar 19.

Electronic health record nudges to optimize guideline-directed medical therapy for heart failure

Michael A Fuery  1 , Katherine A Clark  1 , Nikhil V Sikand  1 , Sara R Tabtabai  1 , Sounok Sen  1 , F Perry Wilson  2   3 , Nihar R Desai  1 , Tariq Ahmad  1 , Marc D Samsky  4
Affiliations
Review

Electronic health record nudges to optimize guideline-directed medical therapy for heart failure

Michael A Fuery et al. Heart Fail Rev. 2025 Jul.

Abstract

Electronic health record (EHR) alert nudges are emerging as a valuable tool for improving heart failure (HF) management, particularly by enhancing the use of guideline-directed medical therapy (GDMT). These nudges, integrated as clinical decision support (CDS) tools within EHR systems, provide real-time, evidence-based prompts that assist clinicians in making informed treatment decisions at critical moments in patient care. Studies have shown that targeted alerts can improve GDMT adherence and outcomes. Designing effective nudges requires aligning alert content, timing, and format with clinician workflows to reduce alert fatigue and enhance usability. Furthermore, involving clinicians in the design process helps ensure alerts are relevant, context-sensitive, and integrated smoothly into practice. EHR nudges present an innovative approach to bridging quality gaps in HF care by encouraging timely interventions and adherence to best practices, but their efficacy depends on thoughtful implementation. Future research is needed to refine alert strategies, optimize their impact on clinical outcomes, and explore their role across diverse healthcare settings, ultimately advancing the potential of EHR nudges to improve HF care quality.

Keywords: Electronic health record (EHR); Guideline-directed medical therapy (GDMT); Heart failure; Nudge.

PubMed Disclaimer

Conflict of interest statement

Declarations. Disclosures: Drs. Fuery, Clark, Tabtabai, Sen, and Samsky have no conflicts of interest or financial ties to disclose. Dr. Sikand reports being a consultant for Bristol Myers Squibb and Bayer. Dr. Wilson reports grant funding from NIDDK, AHRQ, DOD, Amgen, Boeringher-Ingelheim, and Whoop and consulting for Aura.Care and WndrHLTH. Dr Ahmad has received consulting fees from Sanofi, Amgen, and Cytokinetics; and research funding from AstraZeneca, Boehringer Ingelheim, Cytokinetics, and Relypsa. Dr. Desai works under contract with the Centers for Medicare and Medicaid Services to develop and maintain performance measures used for public reporting and pay-for-performance programs. He also reports research grants and consulting for Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CSL Behring, Cytokinetics, Merck, Novartis, SCPharmaceuticals, and Vifor. Competing Interests: The authors declare no competing interests.

References

    1. Chen Y, Harris S, Rogers Y, Ahmad T, Asselbergs FW (2022) Nudging within learning health systems: next generation decision support to improve cardiovascular care. Eur Heart J 43(13):1296-1306A. https://doi.org/10.1093/EURHEARTJ/EHAC030 - DOI - PubMed - PMC
    1. Kao DP, Trinkley KE, Lin CT (2020) Heart failure management innovation enabled by electronic health records. JACC Heart Fail 8(3):223–233. https://doi.org/10.1016/j.jchf.2019.09.008 - DOI - PubMed - PMC
    1. Fuery MA, Kadhim B, Samsky MD et al (2023) Electronic health record embedded strategies for improving care of patients with heart failure. Curr Heart Fail Rep 20(4):280–286. https://doi.org/10.1007/s11897-023-00614-0 - DOI - PubMed
    1. Heidenreich PA, Bozkurt B, Aguilar D et al (2022) 2022 AHA/ACC/HFSA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 79(17):1757–1780. https://doi.org/10.1016/J.JACC.2021.12.011 - DOI - PubMed
    1. Kittleson MM, Breathett K, Ziaeian B, et al. 2024 Update to the 2020 ACC/AHA clinical performance and quality measures for adults with heart failure: a report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures. Circ Cardiovasc Qual Outcomes. Published online August 8, 2024. https://doi.org/10.1161/HCQ.0000000000000132

LinkOut - more resources