An interventional study of Alert and Peer comparison report in Heart Failure, sponsored by VA Office of Research and Development. Completed at 1 site in United States. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-05-01.
Sponsored by VA Office of Research and Development · Not applicable, Interventional, and Health services research
This study addresses a critical gap of care for Veterans with heart failure (HF). Only 1/3 or fewer eligible Veterans are receiving recommended SGLT2 and MRA therapies that save lives and prevents HF hospitalizations. The investigators will compare the effect of clinician directed nudges as strategies to improve the health of Veterans with HF.
This study addresses a critical gap in quality of care for Veterans with heart failure (HF). Only 1/3 or fewer eligible Veterans are receiving SGLT2 inhibitors and mineralocorticoid receptor antagonists, both medications that save lives and prevents HF hospitalizations. The investigators will combine insights from behavioral science and quality improvement science to create two types of 'nudges' - informational alerts and peer comparison feedback - to increase prescribing of these medications. The investigators will create two types of 'nudges' - informational alerts and peer comparison feedback - to increase prescribing of these medications. The investigators will compare the effect of these two nudge strategies alone and in combination compared to usual care. This project will develop simple, scalable, and low-cost strategies to improve the health of Veterans with HF.
5,701 studies on the registry are indexed under Heart Failure; 1,220 are open to participants now.
This study's enrollment of 81 is above the median of 72 across 3,736 interventional studies indexed under Heart Failure.
Browse Heart Failure studies →VA Office of Research and Development is the lead sponsor of 1,733 studies on the registry; 396 are open to participants now.
Of its 206 completed or terminated interventional studies of FDA-regulated products, 180 (87%) have results posted.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Clinicians assigned to peer comparison, will receive messages by secure email every two weeks regarding their SGLT2i and MRA prescribing performance.
Behavioral: Peer comparison report
Clinicians in the alert arm will receive an alert two business days prior to a patient's upcoming appointment. Clinicians will receive approximately two alerts per week.
Behavioral: Alert
The combined alert and peer comparison arm will receive both interventions.
Behavioral: Alert · Behavioral: Peer comparison report
No alert or peer comparison
Interruptive alert. The prototype alert is in the form of a chart note with evidence-based practice guidelines that will actively display in the clinician's list of daily alerts (like an inbox) that must be cleared daily. It is interruptive because can only be dismissed from the clinician's inbox list after signing the note
Clinicians will receive an email describing their recent SGLT2 and MRA prescribing performance relative to their peers.
Effectiveness (MRA Prescriptions)
The primary effectiveness outcome is the amount of SGLT2 or MRA prescriptions in eligible HF patients in the three intervention groups compared with the control group within 30 days of appointment. Thirty days is a common time interval for HF outcomes assessment and allows for chart documentation, care coordination, laboratory testing, and medication prescribing that may occur days after a patient encounter. The investigators will record all SGLT2 or MRA prescriptions, including those from non-targeted clinicians, given that nudge interventions, especially the informational alert, may impact other clinicians directly (e.g., view alert in EHR) or indirectly (e.g., referral from targeted clinician). Data represent a cumulative number of prescriptions filled.
Time frame: 30 days
Effectiveness (SGLT2 Prescriptions)
The primary effectiveness outcome is the amount of SGLT2 or MRA prescriptions in eligible HF patients in the three intervention groups compared with the control group within 30 days of appointment. Thirty days is a common time interval for HF outcomes assessment and allows for chart documentation, care coordination, laboratory testing, and medication prescribing that may occur days after a patient encounter. The investigators will record all SGLT2 or MRA prescriptions, including those from non-targeted clinicians, given that nudge interventions, especially the informational alert, may impact other clinicians directly (e.g., view alert in EHR) or indirectly (e.g., referral from targeted clinician). Data represent a cumulative number of prescriptions filled.
Time frame: 30 days
Reach-Clinician
Reach will be measured at the clinician level as the number of unique clinicians who received an informational alert or peer comparison report. The control group did not receive any alert.
Time frame: 6 months
Incidence of Treatment Emergent Adverse Events
The investigators will measure safety as the number of patients who were deemed by the participant (clinician) to discontinued prescribed medicine due to suspected adverse effects within 30 days of the nudge interventions.
Time frame: 30 days
Implementation-Acceptability
Implementation will be assessed by clinician-directed survey of Acceptability of intervention Measure. The REDCap survey was on the Likert Scale: minimum 1 and maximum 5. With 5 being the highest. Acceptability was determine by the number of participants who were neutral or positive with their responses according the the Likert Scale. The anonymous surveys were sent to all in the three groups and did not collect any identifying information.
Time frame: 6 months
Reach-Patient
At the patient level, Reach will be measured as the number of unique patients for whom the participants received informational alerts
Time frame: 6 months
Reach-Comparison of Strategies
The investigators will measure the proportion of alerts relative to the total number of eligible patients with HF; this denominator will allow for comparisons of representativeness of the alert strategy.
Time frame: 6 months
Implementation-Appropriateness
Appropriateness will be assessed by clinician direct survey of Intervention Appropriateness Measure. Likert scale: minimum 1 and maximum 5. With 5 being the highest. The number of respondents who were neutral and positive were counted. The anonymous surveys were sent to all in the three groups and did not collect any identifying information.
Time frame: 6 months
Implementation-Feasibility
Feasibility will be assessed by clinician direct survey of Feasibility of Intervention Measure. Likert scale: minimum 1 and maximum 5. With 5 being the highest. The survey participants responded used the Likert scale to determine if the intervention would be feasible. All responses neutral or positive were counted. The anonymous surveys were sent to all in the three groups and did not collect any identifying information.
Time frame: 6 months
All employed providers within Cardiology and Primary Care units were enrolled into this study per agreement with management.
| Milestone | Control | Alert | Peer Comparison Report | Alert & Peer Comparison Report |
|---|---|---|---|---|
| Started | 19 | 19 | 21 | 22 |
| Completed | 19 | 19 | 21 | 22 |
| Not completed | 0 | 0 | 0 | 0 |
The primary effectiveness outcome is the amount of SGLT2 or MRA prescriptions in eligible HF patients in the three intervention groups compared with the control group within 30 days of appointment. Thirty days is a common time interval for HF outcomes assessment and allows for chart documentation, care coordination, laboratory testing, and medication prescribing that may occur days after a patient encounter. The investigators will record all SGLT2 or MRA prescriptions, including those from non-targeted clinicians, given that nudge interventions, especially the informational alert, may impact other clinicians directly (e.g., view alert in EHR) or indirectly (e.g., referral from targeted clinician). Data represent a cumulative number of prescriptions filled.
| Count of MRA prescriptions Filled | Control | Alert | Peer Comparison Report | Both Alert and Peer Comparison Report |
|---|---|---|---|---|
| Effectiveness (MRA Prescriptions) | 0 | 2 | 2 | 2 |
Reach will be measured at the clinician level as the number of unique clinicians who received an informational alert or peer comparison report. The control group did not receive any alert.
| Participants | Control | Alert | Peer Comparison Report | Both Alert and Peer Comparison Report |
|---|---|---|---|---|
| Reach-Clinician | 0 | 19 | 21 | 22 |
The investigators will measure safety as the number of patients who were deemed by the participant (clinician) to discontinued prescribed medicine due to suspected adverse effects within 30 days of the nudge interventions.
| Deprescribed patients | Alert (Group 2) SGLT2 Deprescribed | Peer Comparison Report (Group 3) SGLT2 Deprescribed | Alert & Peer Comparison Report (Group 4) SGLT2 Deprescribed | Alert (Group 2) MRA Deprescribed | Peer Comparison Report (Group 3) MRA Deprescribed | Alert & Peer Comparison Report (Group 4) MRA Deprescribed |
|---|---|---|---|---|---|---|
| Incidence of Treatment Emergent Adverse Events | 3 | 0 | 2 | 1 | 0 | 0 |
Implementation will be assessed by clinician-directed survey of Acceptability of intervention Measure. The REDCap survey was on the Likert Scale: minimum 1 and maximum 5. With 5 being the highest. Acceptability was determine by the number of participants who were neutral or positive with their responses according the the Likert Scale. The anonymous surveys were sent to all in the three groups and did not collect any identifying information.
| Participants | All Participants (Clinicians) Completed Survey |
|---|---|
| Acceptability of the Intervention Measure for the Alert | 4 |
| Acceptability of the Intervention Measure for the Peer Comparison Report | 2 |
At the patient level, Reach will be measured as the number of unique patients for whom the participants received informational alerts
| Total unique patients | Number of Patients |
|---|---|
| Reach-Patient | 604 |
The investigators will measure the proportion of alerts relative to the total number of eligible patients with HF; this denominator will allow for comparisons of representativeness of the alert strategy.
| alerts sent | Control | Alert | Peer Comparison Report | Alert & Peer Comparison Report |
|---|---|---|---|---|
| Reach-Comparison of Strategies | 0 | 211 | 202 | 191 |
Appropriateness will be assessed by clinician direct survey of Intervention Appropriateness Measure. Likert scale: minimum 1 and maximum 5. With 5 being the highest. The number of respondents who were neutral and positive were counted. The anonymous surveys were sent to all in the three groups and did not collect any identifying information.
| Participants | All Participants (Clinicians) Completed Survey |
|---|---|
| Intervention Appropriateness Measure for the Alert | 5 |
| Intervention Appropriateness Measure for the Peer Comparison Report | 0 |
Feasibility will be assessed by clinician direct survey of Feasibility of Intervention Measure. Likert scale: minimum 1 and maximum 5. With 5 being the highest. The survey participants responded used the Likert scale to determine if the intervention would be feasible. All responses neutral or positive were counted. The anonymous surveys were sent to all in the three groups and did not collect any identifying information.
| Participants | All Participants (Clinicians) Completed Survey |
|---|---|
| Feasibility of the Intervention Measure for the Alert | 4 |
| Feasibility of the Intervention Measure for the Peer Comparison Report | 1 |
The primary effectiveness outcome is the amount of SGLT2 or MRA prescriptions in eligible HF patients in the three intervention groups compared with the control group within 30 days of appointment. Thirty days is a common time interval for HF outcomes assessment and allows for chart documentation, care coordination, laboratory testing, and medication prescribing that may occur days after a patient encounter. The investigators will record all SGLT2 or MRA prescriptions, including those from non-targeted clinicians, given that nudge interventions, especially the informational alert, may impact other clinicians directly (e.g., view alert in EHR) or indirectly (e.g., referral from targeted clinician). Data represent a cumulative number of prescriptions filled.
| Count of SGLT2 Prescriptions Filled | Control | Alert | Peer Comparison Report | Both Alert and Peer Comparison Report |
|---|---|---|---|---|
| Effectiveness (SGLT2 Prescriptions) | 2 | 24 | 1 | 16 |
Collected over From enrollment through intervention completion, an average of 6 months. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Control | 0/19 (0%) | 0/19 (0%) | 0/19 (0%) |
| Alert | 0/19 (0%) | 0/19 (0%) | 0/19 (0%) |
| Peer Comparison Report | 0/21 (0%) | 0/21 (0%) | 0/21 (0%) |
| Alert & Peer Comparison Report | 0/22 (0%) | 0/22 (0%) | 0/22 (0%) |
Baseline characteristic data was not collected for participants of this study
| Age, Customized | Control | Alert | Peer Comparison Report | Alert & Peer Comparison Report | Total |
|---|
| Sex/Gender, Customized | Control | Alert | Peer Comparison Report | Alert & Peer Comparison Report | Total |
|---|
| Race and Ethnicity Not Collected(Participants) | Control | Alert | Peer Comparison Report | Alert & Peer Comparison Report | Total |
|---|
Documents are hosted by the registry — open the source record to download them.
Plan to share: Yes — There is a plan to make IPD and related data dictionaries available. A Limited Dataset (LDS) will be created and shared pursuant to a Data Use Agreement (DUA) appropriately limiting use of the dataset and prohibiting the recipient from identifying or re-identifying (or taking steps to identify or re-identify) any individual whose data are included in the dataset.
Supporting information: Study protocol, Sap, Icf, Analytic code
This study is completed, as verified in Apr 2026. You cannot join it, but the record below documents what was studied.
Get an email when the registry record changes — status, dates, results — or when someone posts here.
Sign in to followQuestions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.
Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.
Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.
VA Office of Research and Development