Bucher Heiner C, Rickenbach Martin, Young Jim, Glass Tracy R, Vallet Yannick, Bernasconi Enos, Cavassini Matthias, Fux Christoph, Schiffer Véronique, Vernazza Pietro, Weber Rainer, Battegay Manuel
Basel Institute for Clinical Epidemiology & Biostatistics, Basel, Switzerland.
Antivir Ther. 2010;15(1):31-40. doi: 10.3851/IMP1475.
Exposure to combination antiretroviral therapy (cART) can lead to important metabolic changes and increased risk of coronary heart disease (CHD). Computerized clinical decision support systems have been advocated to improve the management of patients at risk for CHD but it is unclear whether such systems reduce patients' risk for CHD.
We conducted a cluster trial within the Swiss HIV Cohort Study (SHCS) of HIV-infected patients, aged 18 years or older, not pregnant and receiving cART for >3 months. We randomized 165 physicians to either guidelines for CHD risk factor management alone or guidelines plus CHD risk profiles. Risk profiles included the Framingham risk score, CHD drug prescriptions and CHD events based on biannual assessments, and were continuously updated by the SHCS data centre and integrated into patient charts by study nurses. Outcome measures were total cholesterol, systolic and diastolic blood pressure and Framingham risk score.
A total of 3,266 patients (80% of those eligible) had a final assessment of the primary outcome at least 12 months after the start of the trial. Mean (95% confidence interval) patient differences where physicians received CHD risk profiles and guidelines, rather than guidelines alone, were total cholesterol -0.02 mmol/l (-0.09-0.06), systolic blood pressure -0.4 mmHg (-1.6-0.8), diastolic blood pressure -0.4 mmHg (-1.5-0.7) and Framingham 10-year risk score -0.2% (-0.5-0.1).
Systemic computerized routine provision of CHD risk profiles in addition to guidelines does not significantly improve risk factors for CHD in patients on cART.
接受联合抗逆转录病毒疗法（cART）会导致重要的代谢变化，并增加冠心病（CHD）风险。计算机化临床决策支持系统已被提倡用于改善冠心病高危患者的管理，但尚不清楚此类系统是否能降低患者患冠心病的风险。
我们在瑞士HIV队列研究（SHCS）中对年龄18岁及以上、非妊娠且接受cART超过3个月的HIV感染患者进行了一项整群试验。我们将165名医生随机分为两组，一组仅接受冠心病危险因素管理指南，另一组接受指南加冠心病风险概况。风险概况包括基于每半年评估的弗雷明汉风险评分、冠心病药物处方和冠心病事件，并由SHCS数据中心持续更新，研究护士将其整合到患者病历中。观察指标为总胆固醇、收缩压和舒张压以及弗雷明汉风险评分。
共有3266名患者（占 eligible患者的80%）在试验开始后至少12个月对主要结局进行了最终评估。当医生接受冠心病风险概况和指南而非仅接受指南时，患者的平均（95%置信区间）差异为：总胆固醇-0.02 mmol/l（-0.09 - 0.06），收缩压-0.4 mmHg（-1.6 - 0.8），舒张压-0.4 mmHg（-1.5 - 0.7），弗雷明汉10年风险评分-0.2%（-0.5 - 0.1）。
除指南外系统性地通过计算机提供冠心病风险概况并不能显著改善接受cART治疗患者的冠心病危险因素。
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