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Published online: 2020-09-21
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Leveraging clinical decision support tools to improve guideline-directed medical therapy in patients with atherosclerotic cardiovascular disease at hospital discharge

Anish Vani, Karen Kan, Eduardo Iturrate, Dina Levy-Lambert, Nathaniel R. Smilowitz, Archana Saxena, Martha J. Radford, Eugenia Gianos
DOI: 10.5603/CJ.a2020.0126
·
Pubmed: 32986236

open access

Ahead of print
Original articles
Published online: 2020-09-21

Abstract

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.

Abstract

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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Keywords

cardiovascular disease, secondary prevention, guideline-directed medical therapy, optimal medical therapy, best practice alerts, clinical decision support tools, electronic health records

About this article
Title

Leveraging clinical decision support tools to improve guideline-directed medical therapy in patients with atherosclerotic cardiovascular disease at hospital discharge

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2020-09-21

DOI

10.5603/CJ.a2020.0126

Pubmed

32986236

Keywords

cardiovascular disease
secondary prevention
guideline-directed medical therapy
optimal medical therapy
best practice alerts
clinical decision support tools
electronic health records

Authors

Anish Vani
Karen Kan
Eduardo Iturrate
Dina Levy-Lambert
Nathaniel R. Smilowitz
Archana Saxena
Martha J. Radford
Eugenia Gianos

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