Key result
Nurse collaboration for CVD risk scoring increased appropriate statin initiation to 33.3% in moderate-risk and 28.6% in high-risk patients, compared to 0% and 9.1% at baseline.
Why the study?
The study evaluated two methods of providing CVD risk scores to determine their effect on appropriate statin therapy for primary prevention of CVD in family medicine clinics.
Does nurse collaboration in providing ASCVD risk scores and therapy recommendations improve appropriate statin initiation in primary prevention patients?
Observational (n=162)
Yes
Does nurse collaboration in providing ASCVD risk scores and therapy recommendations improve appropriate statin initiation in primary prevention patients?
Collaborative nurse involvement in calculating and presenting ASCVD risk scores with therapy recommendations significantly improves guideline-concordant statin initiation compared to passive EMR alerts.
Nurse collaboration was associated with higher statin initiation in this cohort; leaves open whether it improves outcomes in randomized trials.
OBJECTIVES: This study compares two methods of providing CVD risk score on the percentage of appropriate statin therapy for primary prevention of CVD in family medicine clinics, according to the American Heart Association guidelines. METHODS: Participants were non-diabetic patients aged 40 to 75 with a recently ordered low-density lipoprotein (LDL) level, not on statin therapy and free of CVD. The first intervention is passive with a display of the score on the EMR in the vital signs section and lasted for three months. The second intervention is collaborative where the nurses calculate the risk score and displayed it to the physician along with therapy recommendations. Electronic health records were reviewed to randomly select medical charts of eligible patients. RESULTS: 162 charts were randomly selected out of 547 eligible charts and included in the analysis, including 60 charts for the baseline group. Among moderate-risk patients, the percentage of appropriate statin initiation was 0% at baseline and after intervention 1; yet it increased to (33.3% [7.5-70.1, 95% CI]) after intervention 2. Among high risk patients, percentage of appropriate statin initiation was 9.1% [0.1-41.3, 95% CI], 11.1% [1.4, 34.7, 95% CI] and 28.6% [8.4, 58.1, 95% CI] during baseline, intervention 1 and intervention 2, respectively. CONCLUSION: The provision of the CVD risk score alone as clinical decision support is not enough to improve statin initiation for primary prevention. The nurse collaboration can improve guideline-concordant statin initiation.
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Alameddine et al. (2020) conducted an observational in Primary prevention of cardiovascular disease (n=162). Nurse collaboration for CVD risk score calculation and therapy recommendations vs. Passive EMR display of risk score and baseline usual care was evaluated on Percentage of appropriate statin therapy initiation. Nurse collaboration for CVD risk scoring increased appropriate statin initiation to 33.3% in moderate-risk and 28.6% in high-risk patients, compared to 0% and 9.1% at baseline.
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