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Rationale and design of a pragmatic trial aimed at improving treatment of hyperlipidemia in outpatients with very high risk atherosclerotic cardiovascular disease: A pragmatic trial of messaging to providers about treatment of hyperlipidemia (PROMPT-LIPID).
Shah, Nimish N; Ghazi, Lama; Yamamoto, Yu; Martin, Melissa; Simonov, Michael; Riello, Ralph J; Faridi, Kamil F; Ahmad, Tariq; Wilson, F Perry; Desai, Nihar R.
Afiliação
  • Shah NN; Section of Cardiovascular Medicine, New Haven, CT.
  • Ghazi L; Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, CT.
  • Yamamoto Y; Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, CT.
  • Martin M; Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, CT.
  • Simonov M; Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, CT.
  • Riello RJ; Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, CT.
  • Faridi KF; Section of Cardiovascular Medicine, New Haven, CT.
  • Ahmad T; Section of Cardiovascular Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, CT.
  • Wilson FP; Section of Cardiovascular Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, CT.
  • Desai NR; Section of Cardiovascular Medicine, New Haven, CT; Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, CT. Electronic address: Nihar.Desai@Yale.edu.
Am Heart J ; 253: 76-85, 2022 11.
Article em En | MEDLINE | ID: mdl-35841944
ABSTRACT

BACKGROUND:

Despite guideline recommendations to optimize low-density lipoprotein cholesterol (LDL-C) reduction with intensification of lipid-lowering therapy (LLT) in patients with atherosclerotic cardiovascular disease (ASCVD), few of these patients achieve LDL-C < 70 mg/dL in practice.

PURPOSE:

We developed a real-time, targeted electronic health record (EHR) alert with embedded ordering capability to promote intensification of evidence based LLT in outpatients with very high risk ASCVD.

METHODS:

We designed a pragmatic, multicenter, single-blind, cluster randomized trial to test the effectiveness of an EHR-based LLT intensification alert. The study will enroll about 100 providers who will be randomized to either receive the alert or undergo usual care for outpatients with high risk ASCVD with LDL-C > 70 mg/dL. Total enrollment will include 2,500 patients. The primary outcome will be the proportion of patients with LLT intensification at 90 days. Secondary outcomes include achieved LDL-C at 6 months and the proportion of patients with LDL-C < 70 mg/dL or < 55 mg/dL at 6 months.

RESULTS:

Enrollment of 1,250 patients (50% of goal) was reached within 47 days (50% women, mean age 72, median LDL-C 91). At baseline, 71%, 9%, and 3% were on statins, ezetimibe, or proprotein convertase subtilisin/kexin type 9 inhibitors, respectively.

CONCLUSIONS:

PRagmatic Trial of Messaging to Providers about Treatment of HyperLIPIDemia has rapidly reached 50% enrollment of patients with very high risk ASCVD, demonstrating low baseline LLT utilization. This pragmatic, EHR-based trial will determine the effectiveness of a real-time, targeted EHR alert with embedded ordering capability to promote LLT intensification. Findings from this low-cost, widely scalable intervention to improve LDL-C may have important public health implications. TRIAL REGISTRATION clinicaltrials.gov NCT04394715.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Doenças Cardiovasculares / Aterosclerose / Hiperlipidemias Tipo de estudo: Clinical_trials / Etiology_studies / Guideline / Risk_factors_studies Limite: Aged / Female / Humans / Male Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Doenças Cardiovasculares / Aterosclerose / Hiperlipidemias Tipo de estudo: Clinical_trials / Etiology_studies / Guideline / Risk_factors_studies Limite: Aged / Female / Humans / Male Idioma: En Ano de publicação: 2022 Tipo de documento: Article