Patient Knowledge of Coronary Risk Profile Improves the Effectiveness of Dyslipidemia Therapy

Abstract

Background: Despite increasing evidence that treating dyslipidemia reduces cardiovascular events, many patients do not achieve recommended lipid targets.Methods: To determine whether showing physicians and patients the patient's calculated coronary risk can improve the effectiveness of treating dyslipidemia in a primary care setting, patients were randomized to receive usual care or ongoing feedback regarding their calculated coronary risk and the change in this risk after lifestyle changes, pharmacotherapy, or both to treat dyslipidemia. Outcomes, based on intention-to-treat analysis, included changes in blood lipid levels, coronary risk, and the frequency of reaching lipid targets.Results: Two hundred thirty primary care physicians enrolled 3053 patients. After 12 months of follow-up, 2687 patients (88.0%) remained in the study. After adjustment for baseline lipid values, significantly greater mean reductions in low-density lipoprotein cholesterol levels and the total cholesterol to high-density lipoprotein cholesterol ratio were observed in patients receiving risk profiles (51.2 mg/dL[toconverttomillimolesperliter,multiplyby0.0259] and 1.5, respectively) vs usual care (48.0 mg/dL and 1.3, respectively), but the differences were small (−3.3 mg/dL; 95% confidence interval [CI], −5.4 to −1.1 mg/dL; and −0.1; 95% CI, −0.2 to −0.1, respectively). Patients in the risk profile group were also more likely to reach lipid targets (odds ratio, 1.26; 95% CI, 1.07 to 1.48). A significant dose-response effect was also noted when the impact of the risk profile was stronger in those with worse profiles.Conclusions: Discussing coronary risk with the patient is associated with a small but measurable improvement in the efficacy of lipid therapy. The value of incorporating risk assessment in preventive care should be further evaluated.

Discussing Coronary Risk with Patients to Improve Blood Pressure Treatment: Secondary Results from the CHECK-UP Study

“…The CHECK-UP study was a randomized clinical trial to evaluate the effectiveness of a clinical decision aid to improve the treatment of dyslipidemia and reduce the risk of coronary disease among Canadian patients seen in primary care physicians' offices 15 . Individuals with dyslipidemia were randomly assigned to receive usual care or a personalized risk profile in which the future risk of cardiovascular events and potential benefits of modifying specific risk factors were calculated.…”

Electronic Health Record-Based Patient Identification and Individualized Mailed Outreach for Primary Cardiovascular Disease Prevention: A Cluster Randomized Trial

“…One study of CVD risk messages showed a small favorable effect on LDL cholesterol, but this intervention may have yielded more dramatic findings had there not been such a large cholesterol reduction among the control group. 10 Even though we eventually observed differences in cholesterol lowering, the intervention effect was small. In the intervention group, 83 % did not receive prescription lipid-lowering therapy after 18 months.…”

“…Other CVD primary prevention studies achieved larger effects but required greater resources, and many included multiple contacts with clinicians. 8,10,11,[21][22][23][24] If a measurable positive effect of a more limited intervention like ours can be accomplished at a sufficiently low cost, it may be a worthwhile approach to adopt. If the process of delivering these messages can be fully automated (such as using a patient portal connected to the electronic health record), this may reduce the cost of providing this service further.…”

“…Prior studies with repeated exposure to risk messages and counseling have shown the most favorable results. 8,10,11,22,23 An additional study is needed to examine whether repeated delivery increases efficacy.…”

“…There is some evidence that primary prevention approaches that use calculation of CVD risk lead to increased treatment of risk factors by physicians, and can increase patients' intent to start therapies, such as lipid-lowering medication or aspirin, by about 15 to 30 %. [7][8][9][10][11][12][13] Data contained in an electronic health record (EHR) can be used to identify candidates for risk-reducing interventions. 14,15 Automated identification of these patients makes possible practice-wide quality improvement activities delivered directly to patients, such as the approach we tested here.…”