Key result
Implementation of an electronic health record best practice alert increased discharge prescriptions for statins by 4.0% (from 67.3% to 71.3%) and antithrombotic agents by 3.1% (from 75.3% to 78.4%).
Why the study?
Guidelines recommend moderate to high-intensity statins and antithrombotic agents in patients with ASCVD, but guideline-directed medical therapy remains suboptimal.
Does an EHR-based clinical decision support tool (Best Practice Alerts) improve the prescription rates of guideline-directed medical therapy at discharge in patients with ASCVD?
Observational (n=11,553)
No
Does an EHR-based clinical decision support tool (Best Practice Alerts) improve the prescription rates of guideline-directed medical therapy at discharge in patients with ASCVD?
Implementation of EHR-based best practice alerts modestly improved the prescription rates of guideline-directed statin and antithrombotic therapies at hospital discharge for patients with ASCVD.
EHR alerts should not yet change ASCVD discharge protocols; leaves open need for randomized outcome trials.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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Vani et al. (2020) conducted an observational in Atherosclerotic cardiovascular disease (ASCVD) (n=11,553). Electronic health record best practice alerts (BPA) vs. Pre-BPA implementation cohort was evaluated on Proportion of ASCVD patients prescribed a moderate or high-intensity statin at the time of discharge (4.0% increase, p=<0.001). Implementation of an electronic health record best practice alert increased discharge prescriptions for statins by 4.0% (from 67.3% to 71.3%) and antithrombotic agents by 3.1% (from 75.3% to 78.4%).
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