Key result
Implementation of educational efforts and EMR order sets increased Lp(a) testing in patients with aortic valve stenosis from 8.5% in 2010 to a peak of 24.2% in 2017 (p<0.001 for trend).
Why the study?
Lipoprotein(a) is causally associated with aortic valve stenosis, but Lp(a) testing among patients with AS is not broadly incorporated into clinical practice.
Does implementation of EMR order sets and educational efforts increase Lp(a) testing in patients with aortic valve stenosis?
Observational (n=3,808)
No
Does implementation of EMR order sets and educational efforts increase Lp(a) testing in patients with aortic valve stenosis?
Absolute Event Rate: 24.2% vs 8.5%
p-value: p=<0.001
Educational and EMR interventions may raise Lp(a) testing; leaves open whether this improves aortic stenosis outcomes.
BACKGROUND AND AIMS: Lipoprotein(a) [Lp(a)] is causally associated with aortic valve stenosis (AS) but Lp(a) testing among AS patients is not broadly incorporated into clinical practice. We evaluated trends in Lp(a) testing in an academic medical center. METHODS: Educational efforts and adding Lp(a) to the lipid panel on the electronic medical record (EMR) and pre-procedure order sets were used to increase awareness of Lp(a) as a risk factor in AS. Medical records at University of California San Diego Health (UCSDH) were analyzed from 2010 to 2020 to define the yearly frequency of first time Lp(a) testing in patients with diagnosis codes for AS or undergoing transcatheter aortic valve replacement (TAVR). RESULTS: Lp(a) testing for any indication increased over 5-fold from 2010 to 2020. A total of 3808 patients had a diagnosis of AS and 417 patients had TAVR. Lp(a) levels >30 mg/dL were present in 37% of AS and 35% of TAVR patients. The rates of Lp(a) testing in AS and TAVR were 14.0% and 65.7%, respectively. In AS, Lp(a) testing increased over time from 8.5% in 2010, peaking at 24.2% in 2017, and declining to 13.9% in 2020 (p < 0.001 for trend). Following implementation of EMR order-sets in 2016, Lp(a) testing in TAVR cases increased to a peak of 88.5% in 2018. CONCLUSIONS: Elevated Lp(a) is prevalent in AS and TAVR patients. Implementation of educational efforts and practice pathways resulted in increased Lp(a) testing in patients with AS. This study represents a paradigm that may allow increased global awareness of Lp(a) as a risk factor for AS.
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Bhatia et al. (2022) conducted an observational in Aortic valve stenosis (n=3,808). Educational efforts and EMR order sets for Lp(a) testing vs. Pre-implementation period (2010) was evaluated on Yearly frequency of first time Lp(a) testing (p=<0.001). Implementation of educational efforts and EMR order sets increased Lp(a) testing in patients with aortic valve stenosis from 8.5% in 2010 to a peak of 24.2% in 2017 (p<0.001 for trend).
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