Key Points<\/p>\n
<\/p>\n
The rates of non-guideline concordant statin use among patients with established ASCVD remain high, and may be driven in part by both TI and concerns related to SASE.\u00a0 It is unknown whether personalized electronic reminders can help increase appropriate statin prescriptions among high risk VA patients.<\/p>\n
<\/p>\n
<\/p>\n
On March 5, 2023 Dr. Salim Virani from Aga Khan University in Karachi, Pakistan presented the results of A Randomized Trial Of A Personalized Clinical Decision Support Intervention To Improve Statin Prescribing In Patients With Atherosclerotic Cardiovascular Disease (PCDS Statin)<\/em> during the Late Breaking Clinical Trials Section of ACC.23\/WCC, with simultaneous publication in Circulation.<\/em>1<\/sup><\/p>\n <\/p>\n The creation of the intervention in PCDS Statin was described in previous studies: natural language processing and machine learning algorithms were used to identify details of SASE from patient charts and qualitative interviews were done to determine patients and provider perspectives on SASEs and what data clinicians find helpful when making statin prescription decisions.2\u20134<\/sup>\u00a0 This information was used to create a centrally processed, patient specific, electronic reminder meant to promote statin prescription.<\/p>\n <\/p>\n In this cluster randomized control trial, randomization occurred at the clinic level. Primary care providers of patients in an intervention clinic would receive the electronic reminder 2-7 days prior to the patients visit (synchronous) and at a different timepoint outside of the visit (asynchronous).\u00a0 Reminders included date and type of ASCD diagnosis, current statin and dose, date of last fill, date and type of SASE, and guidelines resources on HIS use and SASE management.\u00a0 The control arm received usual care, which included a patient dashboard that provides information on patient compliance with statin therapy.\u00a0 Clinicians in the intervention sites could opt out of electronic reminders, and reminders were not sent if a clinician did not acknowledge the receipt of three previous alerts.\u00a0 The primary outcome was pre-post change in HIS use.\u00a0 The secondary outcome was pre-post change in overall statin use.\u00a0 An exploratory outcome was pre-post statin adherence using the metric of proportion of days covered.<\/p>\n <\/p>\n Overall, 14 clinics (18427 patients) were randomized to the intervention and 13 clinics to the control (18214 patients). The mean age was 71.1 years and the most common ASCVD phenotype was ischemic heart disease; 41.6% of patients had an SASE identified, 52.4% had diabetes, 96.5% were male, 67.9% were White, and 28.6% were Black. \u00a0Baseline HIS\/overall statin use was 52.6%\/81.0% at intervention sites and 55.6%\/82.2% at usual care sites. Nearly 5000 reminders were sent on 4532 unique patients, with 73% being synchronous reminders and 27% being asynchronous.\u00a0 A total of 37 clinicians (31.6%) in the intervention arm opted out of the reminders.<\/p>\n <\/p>\n This study found a modest but statistically significant positive effect for the primary outcome of HIS use.\u00a0 At the end of the study HIS use among intervention patients was 55.2%, an increase of 1.6%, compared to 53.7% for usual care patients, a decrease in 2.2%.\u00a0 The odds ratio for HIS use with the intervention was 1.06 (95% CI 1.02-1.11).\u00a0 Within the intervention group, this effect was driven by those clinicians who received a reminder, as not all eligible patients had reminders sent to their clinicians because of the algorithms to limit alert fatigue: the absolute change was +10.1% in HIS for those who received a reminder versus a -0.18% change among those who did not receive a reminder.\u00a0 Therefore, there was a \u201cnumber needed to remind\u201d of 10 for each HIS prescription.\u00a0 For the secondary outcome, overall statin use actually decreased in both groups, but it decreased less in intervention group (-2.4%) compared to the control group (-5.2%), with an odds ratio for any statin use with the intervention of 1.12 (95% CI 1.06-1.18). \u00a0Gains in overall statin adherence was higher in the intervention group (+6.4%) compared to the usual care group (+3.6%), odds ratio 1.38 (95% CI 1.32-1.45).<\/p>\n <\/p>\n In conclusion, sending centrally processed, electronic reminders tailored with patient-specific information to primary care providers of VA patients with established ASCVD led to an increase is HIS use, an increase in statin adherence, and lower decrease in overall statin use when compared to usual care.\u00a0 Because of algorithms to avoid alarm fatigue and clinician drop out, only 53% of eligible patients actually had a reminder sent, and the effect size in this \u201cper-protocol\u201d group was much higher as compared to the \u201cintention to treat\u201d group.\u00a0 This trial was unique in its use of using both structured data as well as natural language processing to tailor the reminders to the specific patient with the goal of increasing HIS uptake.\u00a0 These results \u201cinform how informatic driven interventions can improve evidence-based care delivery in large healthcare systems,\u201d according to Dr. Virani.\u00a0 \u201cIt will be important to see what the long term outcomes of these patients are as we follow them for another year.\u201d<\/p>\n References<\/strong><\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" Key Points Despite guideline recommendations, both statin use overall and high intensity statin (HIS) use specifically remains low in patients with established atherosclerotic cardiovascular disease (ASCVD). Both therapeutic inertia (TI) and concerns for statin associated side effects (SASE) have been identified as contributors to under-prescribing. In this cluster randomized controlled trial performed in the Department […]<\/p>\n","protected":false},"author":40603,"featured_media":137862,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[878,8],"tags":[877,45,47,185],"ppma_author":[1029],"class_list":{"0":"post-137861","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-acc-2023","8":"category-news","9":"tag-acc-2023","10":"tag-conference","11":"tag-featured","12":"tag-news","13":"author-leah-kosyakovsky"},"authors":[{"term_id":1029,"user_id":40603,"is_guest":0,"slug":"leah-kosyakovsky","display_name":"Leah Kosyakovsky","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/864bde69f6f1f80e91e4a97f0a0ba8daa64c2bb702be09ed787444c7dfa045bb?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/137861","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40603"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=137861"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/137861\/revisions"}],"predecessor-version":[{"id":137863,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/137861\/revisions\/137863"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/137862"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=137861"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=137861"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=137861"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=137861"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n