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

This observational, quality initiative evaluated the impact of changing from a passive (dismissible) to an active (nondismissible without action) electronic health record alert on guideline-recommended lipid-lowering therapy (LLT) prescriptions in patients with recent myocardial infarction at risk for secondary events.

We sequentially recruited a retrospective passive-alert (February 2018-July 2019; n=733) and a prospective active-alert (August 2020-January 2022; n=587) cohort of patients who triggered an alert to intensify LLT or order a low-density lipoprotein-cholesterol (LDL-C) test if they had a recent myocardial infarction (within 12 months) and elevated (≥70 mg/dL) or missing LDL-C. Prescribed LLTs and cumulative percentages of patients with missing or LDL-C <70 and <55 mg/dL were assessed in 6-month periods up to 24 months. Reasons for not intensifying LLTs were recorded with the active alert.

During 24 months, statin and high-intensity statin use increased from 59% to 87% and from 39% to 69%, respectively, in the passive-alert cohort. In the active-alert cohort, statin and high-intensity statin use were high and changed minimally (79% to 80% and 70% to 73%), but ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitor use increased from 12% to 35% and from 2% to 8% (odds ratio, 4.69 [95% CI, 3.22-6.96] and 4.07 [95% CI, 1.92-9.46]), respectively. LDL-C testing and LDL-C goal attainment improved in both cohorts. LDL-C not current (41.7%) was the most common reason for not intensifying LLT.

Continued efforts are needed to encourage guideline-directed LLT intensification for patients with a recent myocardial infarction who are at risk of another cardiac event.