Electronic Health Record Alerts to Improve Lipid Lowering After a Recent Myocardial Infarction

Figures

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  Figure 1. Impact of intervention on postindex intensification of guideline‐recommended LLT. A, Passive‐alert cohort (n=733). B, Active‐alert cohort (n=587). Orange dots and lines, blue triangles and lines, green diamonds and lines, and purple squares and lines, represent any statin, high‐intensity statin, ezetimibe, and PCSK9 inhibitor, respectively. LLT indicates lipid‐lowering therapy; and PCSK9, proprotein convertase subtilisin/kexin type 9. *P<0.05 comparing active‐alert cohort with passive‐alert cohort (χ2 test).

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  Figure 2. Impact of intervention on postindex LDL‐C testing and goal attainment at the end of each postindex follow‐up period.* A, LDL‐C measurements. B, Patients with LDL‐C <70 mg/dL. C, Patients with LDL‐C <55 mg/dL. EHR indicates electronic health record; and LDL‐C, low‐density lipoprotein cholesterol. *Evaluated only in patients with LDL‐C values recorded in the EHR using a survival analysis. †Total number of patients in the cohort followed to the end of the study period or to having a recorded LDL‐C value in the EHR before the end of the study period. ‡Total number of patients in the cohort followed to the end of the study period or to having a recorded LDL‐C <70 mg/dL in the EHR before the end of the study period. §Total number of patients in the cohort followed to the end of the study period or to having a recorded LDL‐C <55 mg/dL in the EHR before the end of the study period.

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  Figure 3. Predictors of improved LDL‐C testing and goal attainment.* A, LDL‐C monitoring. B, LDL‐C of <70 mg/dL. C, LDL‐C<55 mg/dL. BMI indicates body mass index; HR, hazard ratio; LDL‐C, low‐density lipoprotein cholesterol; LLT, lipid‐lowering therapy; and PCSK9, proprotein convertase subtilisin/kexin type 9. **P<0.05; ***P<0.01. *For patients with values. †Recorded 6 months before or on index visit. ‡Prescribed during initial 0 to 6 months postindex follow‐up period.

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  Figure 4. Reasons for active alert dismissal. A, Not to prescribe a high‐intensity statin (n=86). B, Not to prescribe ezetimibe (n=413). C, Not to prescribe a PCSK9i (n=379). D, Not to prescribe an LLT (n=878). LDL‐C indicates low‐density lipoprotein cholesterol; LLT, lipid‐lowering therapy; and PCSK9i, proprotein convertase subtilisin/kexin type 9 inhibitor. *Reasons given by<5 patients were combined into the “Other” category.