Department of Medicine, NYU Langone Health, New York, United States.
Division of Cardiology, NYU Langone Health, New York, United States.
Cardiol J. 2022;29(5):791-797. doi: 10.5603/CJ.a2020.0126. Epub 2020 Sep 28.
Guidelines recommend moderate to high-intensity statins and antithrombotic agents in patients with atherosclerotic cardiovascular disease (ASCVD). However, guideline-directed medical therapy (GDMT) remains suboptimal.
In this quality initiative, best practice alerts (BPA) in the electronic health record (EHR) were utilized to alert providers to prescribe to GDMT upon hospital discharge in ASCVD patients. Rates of GDMT were compared for 5 months pre- and post-BPA implementation. Multivariable regression was used to identify predictors of GDMT.
In 5985 pre- and 5568 post-BPA patients, the average age was 69.1 ± 12.8 years and 58.5% were male. There was a 4.0% increase in statin use from 67.3% to 71.3% and a 3.1% increase in antithrombotic use from 75.3% to 78.4% in the post-BPA cohort.
This simple EHR-based initiative was associated with a modest increase in ASCVD patients being discharged on GDMT. Leveraging clinical decision support tools provides an opportunity to influence provider behavior and improve care for ASCVD patients, and warrants further investigation.
指南建议在动脉粥样硬化性心血管疾病（ASCVD）患者中使用中等强度至高强度他汀类药物和抗血栓药物。然而，指南指导的药物治疗（GDMT）仍然不理想。
在这项质量倡议中，电子病历（EHR）中的最佳实践警报（BPA）被用于提醒医生在 ASCVD 患者出院时开具 GDMT。在实施 BPA 前后的 5 个月内比较 GDMT 的使用率。多变量回归用于确定 GDMT 的预测因素。
在 5985 名实施 BPA 前和 5568 名实施 BPA 后患者中，平均年龄为 69.1±12.8 岁，58.5%为男性。在实施 BPA 后，他汀类药物的使用率从 67.3%增加到 71.3%，抗血栓药物的使用率从 75.3%增加到 78.4%。
这项简单的基于 EHR 的举措与 ASCVD 患者出院时接受 GDMT 的比例适度增加有关。利用临床决策支持工具为影响提供者行为和改善 ASCVD 患者的护理提供了机会，值得进一步研究。
