Nihar Desai, MD: PROMPT-Lipid and EHR-Based Interventions for Improving Care

Data from the PROMPT-Lipid trial highlight the potential of advancing technology for improving care among patients with hyperlipidemia.

Presented at the Family Heart Foundation’s 2024 Family Heart Global Summit, results of the trial suggest targeted electronic health record alerts were associated with a greater proportion of a patients undergoing intensification of their lipid-lowering therapy compared with usual care.

“What we found was that when you used or implemented a real time individualized, targeted, tailored alert within the electronic health record system that providers receiving those alerts were significantly more likely to prescribe evidence based lipid lowering therapies for their patients with atherosclerotic cardiovascular disease,” explained lead investigator Nihar Desai, MD, associate professor of Medicine and vice chief of the Section of Cardiovascular Medicine at Yale University School of Medicine, in an interview with HCPLive Cardiology.

Conducted within Yale New Haven Health, the cluster-randomized, pragmatic trial randomized clinicians to receive an EHR alert with individualized lipid-lowering therapy recommendations or no alert for outpatients with very high-risk atherosclerotic cardiovascular disease and LDL-C of 70 mg/dL or greater. The trial’s primary endpoint was incidence of lipid-lowering therapy intensification at 90 days.

The trial’s no-alert group included 47 clinicians and 1370 patients. The patient cohort had a median age of 71 years, 50.1% were female, and the median LDL-C group was 93 mg/dL. The trial’s alert group included 49 clinicians and 1130 patients. The patient cohort had a median age of 72 years, 47% were female and the median LDL-C was 91 mg/dL.

Upon analysis, results suggested lipid-lowering therapy intensification occurred among 14.1% of the alert group and 10.4% of the no-alert group (Odds Ratio [OR], 1.42; 95% Confidence Interval [CI], 0.96–2.10; P = .08). Results also indicated there were numerically greater rates of intensifying statins, ezetimibe, and PCSK9 inhibitor use in the alert group, but these failed to achieve statistical significance. Among those who did not miss the alert, investigators highlighted a more than 2-fold increase in lipid-lowering therapy intensification (OR, 2.33; 95% CI, 1.48 to 3.66; P <.001).

Relevant disclosures for Desai include Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Novartis, and others.

References:

1. Desai, N. A Pragmatic EMR-Based Approach to Improving Lipid Control: the PROMPT-Lipid Trial. Session presented the annual Family Heart Global Summit in Dallas, Texas, on September 23, 2024.
2. Shah NN, Ghazi L, Yamamoto Y, et al. Pragmatic Trial of Messaging to Providers About Treatment of Hyperlipidemia (PROMPT-LIPID): A Randomized Clinical Trial. Circ Cardiovasc Qual Outcomes. 2024;17(5):e010335. doi:10.1161/CIRCOUTCOMES.123.010335