Individualized Reminders Improve Statin Use and Adherence among Veterans with Atherosclerotic Cardiovascular Disease
BACKGROUND:
Statin and high-intensity statin (HIS) use remains low in patients with atherosclerotic cardiovascular disease (ASCVD), and both statin-associated side effects (SASE) and therapeutic inertia play a role.
This multi-site randomized controlled trial (August 2021 – November 2022) compared usual care to personalized reminders in improving the use of high-intensity statins in Veterans with ASCVD. Investigators developed the intervention by constructing algorithms using data via natural language processing (NLP) to identify SASEs – and by performing qualitative interviews to understand patient perspectives on SASEs as well as clinician information needs. Using these data, they produced a personalized care summary of the patient’s statin side effects, prior exposures, and why he/she qualifies for statin use. Investigators then generated a note to the Veteran’s provider 2-7 days before the patient’s visit (synchronous reminders) or outside of the patient’s PCP visit. Reminders included the date and type of ASCVD diagnosis (i.e., ischemic stroke), statin and dose, date of last fill, date and type of SASE, and guideline resources on HIS definition and SASE management. In this trial, investigators randomized 27 primary care clinics (36,641 Veterans): 14 to the intervention (117 clinicians, 18,427 Veterans) and 13 to usual care (128 clinicians, 18,214 Veterans). Usual care was defined as clinician access to a patient dashboard displaying compliance with statin therapy. Outcomes included pre-post change in high-intensity statin use (primary) and statin use (secondary) between the intervention and usual-care sites.
FINDINGS:
- Centrally processed individualized reminders led to a significant increase in high-intensity statin use and statin adherence among Veterans with ASCVD.
- In the intervention arm, the absolute change in HIS was +10% for those who received a reminder versus a -0.18% decrease among those who did not receive a reminder.
- Baseline HIS use at intervention and usual care sites was 54% and 56%, respectively. At the end of the study, HIS use at intervention and usual care sites was 55% and 54%, respectively.
IMPLICATIONS:
- This is the first multisite study leveraging structured data and NLP to provide individualized information to clinicians to improve high-intensity statin use in patients with ASCVD. Centrally controlled reminders allowed rapid upscaling of the intervention to several sites.
- These results can inform future informatics-driven quality improvement initiatives in the VA healthcare system.
AUTHOR/FUNDING INFORMATION:
This research was funded by HSR&D (IIR 16-072). Drs. Virani, Ramsey, Kuebeler, Chen, Akeroyd, and Petersen (Director) are part of HSR&D’s Center for Innovations in Quality, Effectiveness and Safety (IQuESt). Drs. Westerman, Gobbel, and Matheny are part of VA Tennessee Valley Health Care.
Virani S, Ramsey D, Westerman D, Kuebeler M, Chen L, Akeroyd J, Gobbel G, Ballantyne C, Petersen L, Turchin A, and Matheny M. Cluster Randomized Trial of a Personalized Clinical Decision Support Intervention to Improve Statin Prescribing in Patients with Atherosclerotic Cardiovascular Disease (PCDS Statin). Circulation. March 5, 2023; online ahead of print.
