Bangash Hana, Saadatagah Seyedmohammad, Naderian Mohammadreza, Hamed Marwan E, Alhalabi Lubna, Sherafati Alborz, Sutton Joseph, Elsekaily Omar, Mir Ali, Gundelach Justin H, Gibbons Daniel, Johnsen Paul, Wood-Wentz Christina M, Smith Carin Y, Caraballo Pedro J, Bailey Kent R, Kullo Iftikhar J
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Information Technology, Mayo Clinic, Rochester, MN, USA.
NPJ Digit Med. 2024 Mar 18;7(1):73. doi: 10.1038/s41746-024-01069-w.
Severe hypercholesterolemia/possible familial hypercholesterolemia (FH) is relatively common but underdiagnosed and undertreated. We investigated whether implementing clinical decision support (CDS) was associated with lower low-density lipoprotein cholesterol (LDL-C) in patients with severe hypercholesterolemia/possible FH (LDL-C ≥ 190 mg/dL). As part of a pre-post implementation study, a CDS alert was deployed in the electronic health record (EHR) in a large health system comprising 3 main sites, 16 hospitals and 53 clinics. Data were collected for 3 months before ('silent mode') and after ('active mode') its implementation. Clinicians were only able to view the alert in the EHR during active mode. We matched individuals 1:1 in both modes, based on age, sex, and baseline lipid lowering therapy (LLT). The primary outcome was difference in LDL-C between the two groups and the secondary outcome was initiation/intensification of LLT after alert trigger. We identified 800 matched patients in each mode (mean ± SD age 56.1 ± 11.8 y vs. 55.9 ± 11.8 y; 36.0% male in both groups; mean ± SD initial LDL-C 211.3 ± 27.4 mg/dL vs. 209.8 ± 23.9 mg/dL; 11.2% on LLT at baseline in each group). LDL-C levels were 6.6 mg/dL lower (95% CI, -10.7 to -2.5; P = 0.002) in active vs. silent mode. The odds of high-intensity statin use (OR, 1.78; 95% CI, 1.41-2.23; P < 0.001) and LLT initiation/intensification (OR, 1.30, 95% CI, 1.06-1.58, P = 0.01) were higher in active vs. silent mode. Implementation of a CDS was associated with lowering of LDL-C levels in patients with severe hypercholesterolemia/possible FH, likely due to higher rates of clinician led LLT initiation/intensification.
重度高胆固醇血症/可能的家族性高胆固醇血症（FH）相对常见，但诊断不足且治疗不充分。我们调查了实施临床决策支持（CDS）是否与重度高胆固醇血症/可能的FH患者（低密度脂蛋白胆固醇[LDL-C]≥190mg/dL）较低的LDL-C水平相关。作为一项实施前后研究的一部分，在一个由3个主要地点、16家医院和53家诊所组成的大型医疗系统的电子健康记录（EHR）中部署了CDS警报。在实施前3个月（“静默模式”）和实施后3个月（“激活模式”）收集数据。临床医生仅在激活模式下能够在EHR中查看警报。我们根据年龄、性别和基线降脂治疗（LLT），在两种模式下将个体进行1:1匹配。主要结局是两组之间LDL-C的差异，次要结局是警报触发后LLT的启动/强化。我们在每种模式下确定了800例匹配患者（平均±标准差年龄56.1±11.8岁对55.9±11.8岁；两组男性均为36.0%；平均±标准差初始LDL-C 211.3±27.4mg/dL对209.8±23.9mg/dL；每组基线时11.2%接受LLT）。与静默模式相比，激活模式下LDL-C水平低6.6mg/dL（95%CI，-10.7至-2.5；P=0.002）。与静默模式相比，激活模式下高强度他汀类药物使用的几率（OR，1.78；95%CI，1.41-2.23；P<0.001）和LLT启动/强化的几率（OR，1.3；95%CI，1.06-1.58，P=0.01）更高。实施CDS与重度高胆固醇血症/可能的FH患者LDL-C水平降低相关，可能是由于临床医生主导的LLT启动/强化率更高。
