Abstract: TH-OR086
Clinical Decision Support Tool to Enhance Angiotensin-Converting Enzyme Inhibitor (ACEI)/Angiotensin Receptor Blocker (ARB) Use in Patients with CKD
Session Information
- Late-Breaking Research Orals - 1
November 06, 2025 | Location: Grand Ballroom C, Convention Center
Abstract Time: 04:54 PM - 05:06 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
- Gregg, Lucile Parker, Baylor College of Medicine, Houston, Texas, United States
- Richardson, Peter, Baylor College of Medicine, Houston, Texas, United States
- Herrera, Michael Alexander, Baylor College of Medicine, Houston, Texas, United States
- Gobbel, Glenn T., Vanderbilt University, Nashville, Tennessee, United States
- Wydermyer, Sheena R., US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
- Al-Garadi, Mohammed, Vanderbilt University, Nashville, Tennessee, United States
- Westerman, Dax, Vanderbilt University, Nashville, Tennessee, United States
- Virani, Salim S., Baylor College of Medicine, Houston, Texas, United States
- Matheny, Michael Edwin, Vanderbilt University, Nashville, Tennessee, United States
Background
ACEI/ARB use remains low despite being available for clinical use for over three decades. We conducted a clinical trial within the Department of Veterans Affairs to assess whether a personalized clinical decision support tool delivered as a synchronous alert would improve ACEI/ARB use among Veterans with CKD.
Methods
A randomized, controlled trial of primary care providers (PCPs) clustered at PACT (clinic) level was conducted to evaluate a clinical decision support tool for patients with CKD whose ACEI/ARB had been discontinued for ≥90 days . With natural language processing using structured and unstructured data from the electronic medical record, we developed an individualized clinical decision support tool for primary care providers (PCPs) caring for individuals with CKD. After educational webinars were held at two sites (Houston and Nashville VA medical centers) for PCPs, they were randomly selected to receive alerts from October 2024 to July 2025. This patient-specific tool was sent as a synchronous electronic alert to PCPs at intervention sites 2 to 7 days before the patient’s scheduled visit. We assessed ACEI/ARB reinitiation within 30 days after the intervention in both the intervention and control groups, additionally adjusting for demographics and comorbid conditions.
Results
During the study period, synchronous alerts to PCPs were sent for 1508 unique patients who had PCP appointments. Over 80% of the alerts were acknowledged by the PCPs (through electronic medical records). The median age of the study population was 76 years (IQR, 71-80 years), with a baseline median eGFR of 43.9 ml/min (IQR, 30-54.7 ml/min). In the intervention group, ACEI/ARB was reinitiated in 15.9% of patients (compared to 11.0% in the control group, P=.0005) within 30 days of receiving the alert. In a multivariable model that included individuals who were reinitiated on ACEI/ARBs, receipt of alerts was associated with a 50% higher odds (OR 1.50, 95% CI 1.19-1.88, P = .0004) of ACEI/ARB reinitiation.
Conclusion
An individualized clinical decision support tool improved ACEI/ARB use among veterans with CKD. Future studies should confirm these findings in other settings and assess the impact of such alerts on clinical outcomes
Funding
- Other NIH Support