Best Practice Advisory to Initiate High-Intensity Statin Therapy in Patients With Peripheral Artery Disease

Vanderbilt University Medical Center

Status: Completed

Conditions: Peripheral Artery Disease

Treatments: Other: Best Practice Advisory

Study type: Interventional

Funder types: Other

Identifiers

NCT05166187

212294

Details and patient eligibility

About

The purpose of this study is to understand how a Best Practice Advisory (BPA) for high-intensity statin therapy in patients with Peripheral Artery Disease impacts prescription rates.

Full description

The central hypothesis is that an automated best practice advisory embedded within the electronic medical record (EMR) will improve prescription of high-intensity statins among hospitalized patients with Peripheral Artery Disease (PAD).

Aim 1: To assess the impact of an automated best practice advisory, deployed as part of the standard hospital discharge workflow within the electronic medical record, on high-intensity statin prescription among hospitalized patients with PAD.

Aim 2: To assess the impact of an automated best practice advisory, deployed as part of the standard hospital discharge workflow within the electronic medical record, on short-term cardiovascular outcomes among hospitalized patients with PAD.

Enrollment: 152 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Primary hospital diagnosis of PAD defined by ICD/CPT codes
• Inpatient status at the adult hospital at Vanderbilt University Medical Center
• Not currently prescribed a high-intensity statin (atorvastatin 40-80mg daily or rosuvastatin 20-40mg daily)

Exclusion criteria

• On comfort measures
• History of statin allergy or intolerance recorded in the EMR
• History of rhabdomyolysis defined by International Classification of Diseases/Current Procedural Terminology (ICD/CPT) codes
• History of hepatitis A, B, or C defined by ICD/CPT codes
• Pregnant
• Aspartate aminotransferase >120 units/L within 30 days of alert
• Alanine aminotransferase >165 units/L within 30 days of alert
• Primary hospital diagnosis of acute myocardial infarction defined by ICD/CPT codes
• Primary hospital diagnosis of acute stroke defined by ICD/CPT codes

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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152 participants in 2 patient groups

Intervention

Experimental group

Description:

Patients randomized to the intervention arm will have a Best Practice Advisory (BPA) displayed as part of the discharge order workflow. This BPA requires clinicians to choose an option before completing the discharge documentation. Options include ordering one of the appropriate statins or documenting that the medication is contraindicated, the patient declined, or the patient does not meet criteria for a high-intensity statin.

Treatment:

Other: Best Practice Advisory

Usual Care

No Intervention group

Description:

Patients randomized to the usual care arm will have the identical set of windows displayed in the discharge workflow minus the BPA window.