Integrating electronic health records into the study of heart failure: promises and pitfalls

TY - JOUR

T1 - Integrating electronic health records into the study of heart failure

T2 - promises and pitfalls

AU - Vaduganathan, Muthiah

AU - Patel, Ravi B.

AU - Butler, Javed

AU - Metra, Marco

N1 - Funding Information: Future epidemiological studies and clinical trials will continue to utilize EHR-linked data sources to define HF and potentially target interventions moving forward. The potential for integrated EHR-linked data to complement clinical trials has captured the interest of multiple scientific parties, and has even been the subject of a recent US FDA guidance. There is hope that EHR-linked data may identify key gaps in HF care at the population level, improve patient-level care, and promote efficiency and cost savings in clinical trials. The ultimate goal is to tease apart the signal from the noise and to truly hone in on HF patients in an era of big data. Given the rising global burden of HF, the complexity of the syndrome, and the lack of objective metrics to guide its definition, a more nuanced approach to the application of EHR-linked data is required, especially in HFpEF. Conflict of interest: J.B. has received research support from the National Institutes of Health, the European Union, the Health Resource Services Administration and the Food and Drug Administration, and has been a consultant for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Cardiocell, Janssen, Novartis, Relypsa, ZS Pharma, Medtronic, Merck, CVRx and Gilead. All other authors report no conflicts of interest. This article refers to ‘Prognostic burden of heart failure recorded in primary care, acute hospital admissions, or both: a population-based linked electronic health record cohort study in 2.1 million people’ by S. Koudstaal et al., published in this issue on pages 1119–1127. Heart failure (HF) represents a global epidemic: close to a million new cases are identified annually and over 8 million people are expected to be living with the chronic disease by 2030. In the USA alone, over 1 million patients are hospitalized with a primary discharge diagnosis of HF and roughly 30% of these patients die within 1 year. This alarming burden of disease, coupled with high rates of hospital and post-discharge care utilization, has resulted in a substantial economic footprint. The total cost of HF-related care in the USA is expected to rise to $70 billion by 2030. Unfortunately, despite these adverse trajectories, research investment and scientific advancements for patients with HF remain sluggish. For instance, only two novel drugs (combination sacubitril–valsartan and ivabradine) have been approved by the US Food and Drug Administration (FDA) Center for Drug Evaluation and Research as new molecular entities over the last 5 years. The high cost of drug development and the inability to efficiently track patients living with HF have posed major challenges to therapeutic development and effective clinical care in this space. The advent and increased utilization of integrated electronic health record (EHR) systems may improve the capture of real-time data in HF patients. We discuss the promises and pitfalls of EHR-linked data in identifying gaps in care at a population level, improving individual patient care, and optimizing the clinical trial enterprise.

PY - 2017/9

Y1 - 2017/9

UR - http://www.scopus.com/inward/record.url?scp=85019734467&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019734467&partnerID=8YFLogxK

U2 - 10.1002/ejhf.878

DO - 10.1002/ejhf.878

M3 - Editorial

C2 - 28544192

AN - SCOPUS:85019734467

SN - 1388-9842

VL - 19

SP - 1128

EP - 1130

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

IS - 9

ER -