Abstract
Background-Many eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk. Methods and Results-We performed a pragmatic randomized controlled trial at community health centers in 2 states. Participants were men aged ≥35 years and women ≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10%. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8% of intervention and 11.6% of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95% confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1% in the intervention group and 6.0% in the control group (odds ratio, 1.76; [95% confidence interval, 0.90-3.45]). The cholesterol outcome did not differ, and the majority of patients did not repeat lipid levels during follow-up. Conclusions-Risk communication and lay outreach increased cholesterol treatment discussions with primary care clinicians. However, most discussions did not result in statin prescribing. For outreach to be successful, it should be combined with interventions to encourage clinicians to follow contemporary risk-based cholesterol treatment guidelines. Clinical Trial Registration-URL: http://www.clincialtrials.gov. Unique identifier: NCT01610609.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 560-566 |
| Number of pages | 7 |
| Journal | Circulation: Cardiovascular Quality and Outcomes |
| Volume | 8 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 1 2015 |
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Keywords
- cardiovascular diseases
- case management
- cholesterol
- randomized controlled trial
- risk assessment
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
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Individualized Risk Communication and Outreach for Primary Cardiovascular Disease Prevention in Community Health Centers : Randomized Trial. / Persell, Stephen D.; Brown, Tiffany; Lee, Ji Young; Shah, Shreya; Henley, Eric; Long, Timothy; Luther, Stephanie; Lloyd-Jones, Donald M.; Jean-Jacques, Muriel; Kandula, Namratha R.; Sanchez, Thomas; Baker, David W.
In: Circulation: Cardiovascular Quality and Outcomes, Vol. 8, No. 6, 01.12.2015, p. 560-566.Research output: Contribution to journal › Article
TY - JOUR
T1 - Individualized Risk Communication and Outreach for Primary Cardiovascular Disease Prevention in Community Health Centers
T2 - Randomized Trial
AU - Persell, Stephen D.
AU - Brown, Tiffany
AU - Lee, Ji Young
AU - Shah, Shreya
AU - Henley, Eric
AU - Long, Timothy
AU - Luther, Stephanie
AU - Lloyd-Jones, Donald M.
AU - Jean-Jacques, Muriel
AU - Kandula, Namratha R.
AU - Sanchez, Thomas
AU - Baker, David W.
PY - 2015/12/1
Y1 - 2015/12/1
N2 - Background-Many eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk. Methods and Results-We performed a pragmatic randomized controlled trial at community health centers in 2 states. Participants were men aged ≥35 years and women ≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10%. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8% of intervention and 11.6% of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95% confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1% in the intervention group and 6.0% in the control group (odds ratio, 1.76; [95% confidence interval, 0.90-3.45]). The cholesterol outcome did not differ, and the majority of patients did not repeat lipid levels during follow-up. Conclusions-Risk communication and lay outreach increased cholesterol treatment discussions with primary care clinicians. However, most discussions did not result in statin prescribing. For outreach to be successful, it should be combined with interventions to encourage clinicians to follow contemporary risk-based cholesterol treatment guidelines. Clinical Trial Registration-URL: http://www.clincialtrials.gov. Unique identifier: NCT01610609.
AB - Background-Many eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk. Methods and Results-We performed a pragmatic randomized controlled trial at community health centers in 2 states. Participants were men aged ≥35 years and women ≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10%. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8% of intervention and 11.6% of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95% confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1% in the intervention group and 6.0% in the control group (odds ratio, 1.76; [95% confidence interval, 0.90-3.45]). The cholesterol outcome did not differ, and the majority of patients did not repeat lipid levels during follow-up. Conclusions-Risk communication and lay outreach increased cholesterol treatment discussions with primary care clinicians. However, most discussions did not result in statin prescribing. For outreach to be successful, it should be combined with interventions to encourage clinicians to follow contemporary risk-based cholesterol treatment guidelines. Clinical Trial Registration-URL: http://www.clincialtrials.gov. Unique identifier: NCT01610609.
KW - cardiovascular diseases
KW - case management
KW - cholesterol
KW - randomized controlled trial
KW - risk assessment
UR - http://www.scopus.com/inward/record.url?scp=84947725480&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84947725480&partnerID=8YFLogxK
U2 - 10.1161/CIRCOUTCOMES.115.001723
DO - 10.1161/CIRCOUTCOMES.115.001723
M3 - Article
C2 - 26555123
AN - SCOPUS:84947725480
VL - 8
SP - 560
EP - 566
JO - Circulation: Cardiovascular Quality and Outcomes
JF - Circulation: Cardiovascular Quality and Outcomes
SN - 1941-7713
IS - 6
ER -