In a cluster randomized clinical trial of two decision support interventions within an electronic health record (EHR), the passive choice and active choice interventions did not change statin prescribing among cardiologists, according to a study published Oct. 7 in JAMA Cardiology. However, in the subgroup of patients with clinical atherosclerotic cardiovascular disease, the active choice intervention led to a small increase in statin prescribing.

Srinath Adusumalli, MD, MSc, FACC, et al., evaluated the effect of passive choice and active choice interventions in the EHR to promote guideline-directed statin therapy with 82 cardiologists and 11,693 patients at 16 different cardiology practices. In the passive choice option, cardiologists had to manually access an alert embedded in the EHR to select options to initiate or increase statin therapy. In the active choice option, an interruptive EHR alert prompted the cardiologist to accept or decline guideline-directed statin therapy.

This three-arm randomized clinical trial included a six-month preintervention period and six-month intervention, and data were analyzed between May 8, 2019 and Jan. 9, 2020.

Results showed that baseline statin prescribing rates at the optimal dose were 40.3% in the control arm, 39.1% in the passive choice arm and 41.2% in the active choice arm. In adjusted analyses, the authors found that change in statin prescribing rates at optimal dose over time was not significantly different from control for passive choice or active choice.

In adjusted analyses of the subset of patients with clinical atherosclerotic cardiovascular disease, the authors found that active choice intervention resulted in a significant increase in statin prescribing at optimal dose relative to control.

"Further study is needed to evaluate the active choice intervention among patients with clinical atherosclerotic cardiovascular disease, and future interventions could focus on ways to improve the design of active choice and combine it with other approaches to further improve statin prescribing," the authors conclude.

In an accompanying editorial comment, Thomas M. Maddox, MD, MSc, FACC, notes that "although the Adusumalli, et al., study did not result in improved statin prescription, it did provide another, equally important result: learning." He adds, "These insights are valuable contributions to our collective knowledge and move us closer to the EHR potential of effective clinical decision support."

Clinical Topics: Cardiovascular Care Team, Dyslipidemia, Nonstatins, Novel Agents, Statins

Keywords: Decision Support Systems, Clinical, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Electronic Health Records, Cardiovascular Diseases, Prescriptions, Cardiology, Atherosclerosis, Homeodomain Proteins, POU Domain Factors

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