Electronic Health Record Alerts to Improve Lipid Lowering After a Recent Myocardial Infarction

Area of Science:

• Cardiology
• Health Informatics
• Pharmacotherapy

Background:

• Evaluating the impact of electronic health record (EHR) alert systems on guideline-recommended lipid-lowering therapy (LLT) prescriptions.
• Focus on patients with recent myocardial infarction (MI) at high risk for secondary cardiac events.

Purpose of the Study:

• To assess the effectiveness of transitioning from a passive (dismissible) to an active (non-dismissible without action) EHR alert.
• To improve LLT intensification and low-density lipoprotein-cholesterol (LDL-C) management in post-MI patients.

Main Methods:

• Sequential cohort study comparing passive-alert (n=733) and active-alert (n=587) systems.
• Patients with recent MI and elevated or missing LDL-C were included.
• LLT prescriptions, LDL-C testing, and goal attainment were assessed over 24 months.

Main Results:

• Active alerts correlated with increased use of ezetimibe and PCSK9 inhibitors.
• Statin use remained high but showed minimal change with active alerts.
• LDL-C testing and goal attainment improved in both alert systems; 'LDL-C not current' was a key barrier.

Conclusions:

• Active EHR alerts can enhance the use of specific LLTs beyond statins.
• Further interventions are necessary to optimize guideline-directed LLT intensification in high-risk MI patients.
• Addressing reasons for not intensifying LLT, such as incomplete LDL-C data, is critical.