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The effect of computerized decision support systems on cardiovascular risk factors: a systematic review and
T Katrien J Groenhof1, Folkert W Asselbergs2,3,4, Rolf H H Groenwold5,6
1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands. t.k.j.groenhof@umcutrecht.nl.
Insights
Computerized decision support systems (CDSS) show limited clinical benefit for cardiovascular risk management, though some features like patient empowerment show promise. Further research is needed due to variability and heterogeneity in current studies.
Area of Science:
- Cardiology
- Medical Informatics
- Health Services Research
Background:
- Cardiovascular risk management (CVRM) is complex due to multi-morbidity and diverse disease presentations.
- Computerized decision support systems (CDSS) offer potential for integrating evidence into clinical practice for tailored CVRM.
- The impact of CDSS on CVRM effectiveness remains to be conclusively determined.
Purpose of the Study:
- To systematically review and meta-analyze the effects of CDSS on CVRM.
- To identify CDSS characteristics associated with more effective CVRM.
- To evaluate changes in systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-c), and HbA1c levels and target attainment.
Main Methods:
- Systematic review and meta-analysis of 22 eligible studies.
- Methodological appraisal using the Cochrane risk of bias tool.
- Calculation of mean differences and relative risks; random-effects model pooling where I² < 70%.
Main Results:
- A trend towards benefit from CDSS in CVRM patients was observed, but only LDL-c target attainment in diabetes patients was statistically significant.
- Significant heterogeneity in CDSS technical performance and content was noted, often precluding quantitative pooling.
- Prompting, EHR integration, patient empowerment, and medication support were linked to more effective CVRM.
Conclusions:
- No clear clinical benefit of CDSS was found for cardiovascular risk factor levels or target attainment.
- Variability in CDSS and result heterogeneity limit definitive conclusions, indicating an immature research area.
- Future clinical relevance of CDSS in CVRM may lie in enhancing shared decision-making and patient empowerment.
Background:
Cardiovascular risk management (CVRM) is notoriously difficult because of multi-morbidity and the different phenotypes and severities of cardiovascular disease. Computerized decision support systems (CDSS) enable the clinician to integrate the latest scientific evidence and patient information into tailored strategies. The effect on cardiovascular risk factor management is yet to be confirmed.
Methods:
We performed a systematic review and meta-analysis evaluating the effects of CDSS on CVRM, defined as the change in absolute values and attainment of treatment goals of systolic blood pressure (SBP), low density lipoprotein cholesterol (LDL-c) and HbA1c. Also, CDSS characteristics related to more effective CVRM were identified. Eligible articles were methodologically appraised using the Cochrane risk of bias tool. We calculated mean differences, relative risks, and if appropriate (I2 < 70%), pooled the results using a random-effects model.
Results:
Of the 14,335 studies identified, 22 were included. Four studies reported on SBP, 3 on LDL-c, 10 on CVRM in patients with type II diabetes and 5 on guideline adherence. The CDSSs varied considerably in technical performance and content. Heterogeneity of results was such that quantitative pooling was often not appropriate. Among CVRM patients, the results tended towards a beneficial effect of CDSS, but only LDL-c target attainment in diabetes patients reached statistical significance. Prompting, integration into the electronical health record, patient empowerment, and medication support were related to more effective CVRM.
Conclusion:
We did not find a clear clinical benefit from CDSS in cardiovascular risk factor levels and target attainment. Some features of CDSS seem more promising than others. However, the variability in CDSS characteristics and heterogeneity of the results - emphasizing the immaturity of this research area - limit stronger conclusions. Clinical relevance of CDSS in CVRM might additionally be sought in the improvement of shared decision making and patient empowerment.
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