PROMPT-Lipid

In the United States and most developed countries, cardiovascular disease (CVD)—including coronary heart disease, stroke, and peripheral artery disease—is the leading cause of death in men and women. A key risk factor for CVD is dyslipidemia, in particular elevations in low-density lipoprotein cholesterol (LDL-C), whose treatment has been shown to dramatically reduce downstream risks of adverse cardiovascular events. Recent professional society guidelines outline the use of pharmacological therapies for the reduction of LDL-C in very high risk patients. Based on favorable results from several large clinical trials, these guidelines support the use of high intensity statin therapy, and then addition of non-statin therapies if the LDL-C remains elevated.

Despite clear recommendations, there is substantial underuse of evidence based lipid lowering therapies across healthcare systems. Since the benefit of lipid-lowering treatment can only be fully realized if all patients are treated appropriately, there is a strong need for strategies aimed at improving adoption of the practice guidelines and the recommended therapies therein. This is the problem that PROMPT-Lipid seeks to address. Several studies have found that real-time alerting to important clinical conditions, when fired in an appropriate and timely manner and with actionable interventions, can positively impact patient outcomes through increased physician awareness and adherence to best practices.

PROMPT-Lipid seeks to evaluate whether automated electronic alerts with guideline-based recommendations can improve the management of hyperlipidemia among patients at very high risk. 100 physicians from outpatient internal medicine and cardiology practices associated with four teaching hospitals in the Yale New Haven Health System will undergo cluster randomization into the alert group or a non-alert, control group. The alert group physicians will receive an ACC/AHA guideline-directed actionable item upon opening the order entry screen of a patient with hyperlipidemia, while the control group will go through usual care. The primary outcome will be the proportion of patients who have intensification of their lipid lowering therapy at 90 days. The secondary outcomes will be achieved LDL-C at 6-months and rates of hospitalization for myocardial infarction, stroke, unstable angina, coronary or peripheral artery revascularization.