Retrospective Analysis of Lipid-Lowering and Antiplatelet Therapy Regimen by Clinical Decision Support Service Based on Real-World Data from Electronic Medical Records “Intellect 3 Study”

Aim      To evaluate prescription of lipid-lowering and antithrombotic therapy in clinical practice and to compare differences in recommendations using the clinical decision support service (CDSS).

Material and methods  Electronic medical records (EMR) of 300 patients from the Chazov National Medical Research Center of Cardiology, as well as from medical organizations controlled by the Department of Health of the Lipetsk Region and the Ministry of Health of the Voronezh Region, were analyzed for the period of August - December 2022, during the pilot implementation of CDSS. Retrospective information about the prescription of lipid-lowering and antithrombotic therapy from the EMR was compared with the CDSS guidelines under the expert supervision based on digitized clinical and laboratory profiles of patients. The study primary endpoint was a change in the initially prescribed lipid-lowering and / or antithrombotic therapy as per CDSS guidelines.

Results Overall 292 patients were included in the final analysis; 46 (15.7 %) were from the primary prevention group and 246 (84.3 %) from the secondary prevention group. In group 1, the lipid-lowering therapy recommended by the CDSS differed by 50 % (p<0.001) from the baseline therapy recorded in the EMR. In the secondary prevention group, 78.9 % (p<0.001) differences were found in the lipid-lowering therapy recommended in the CDSS guidelines compared to the prescriptions in the EMR. In 76.8 % (p<0.001) of patients, antithrombotic therapy was significantly different from the baseline therapy in the EMR.

Conclusion      The use of CDSS may improve the practice of choosing lipid-lowering and antithrombotic therapy for prevention of cardiovascular complications.

1. Federal State Statistics Service. Russain Statistical Yearbook 2018. Av. at: https://rosstat.gov.ru/storage/mediabank/year18.pdf. -M.: Rosstat;2018. – 694 p. ISBN 978-5-89476-456-6

2. Muromtceva G. A., Kontsevaya A. V., Konstantinov V. V., Artamonova G. V., Gatagonova T. M., Duplyakov D. V. et al. The prevalence of non-infectious disease risk factors in the Russian population in 2012–2013. Results of the ESSE-RF study. Cardiovascular Therapy and Prevention. 2014;13 (6):4–11. DOI: 10.15829/1728-8800-2014-6-4-11

3. Meshkov A. N., Ershova A. I., Deev A. D., Metelskaya V. A., Zhernakova Yu. V., Rotar O. P. et al. Distribution of lipid profile values in economically active men and women in Russian Federation: results of the esse-rf study for the years 2012–2014. Cardiovascular Therapy and Prevention. 2017;16 (4):62–7. DOI: 10.15829/1728-8800-2017-4-62-67

4. Ezhov M. V., Shalnova S. A., Yarovaya E. B., Kutsenko V. A., Evstifeeva S. E., Metelskaya V. A. et al. Lipoprotein (a) in an adult sample from the Russianpopulation: distribution and associationwith atherosclerotic cardiovascular diseases. Archives of Medical Science. 2021;19 (4):995–1002. DOI: 10.5114/aoms/131089

5. Shalnova S. A., Deev A. D., Metelskaya V. A., Evstifeeva S. E., Rotar O. P., Zhernakova Yu. V. et al. Awareness and treatment specifics of statin therapy in persons with various cardiovasular risk: the study ESSE-RF. Cardiovascular Therapy and Prevention. 2016;15 (4):29–37. DOI: 10.15829/1728-8800-2016-4-29-37

6. Collet J-P, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal. 2021;42 (14):1289–367. DOI: 10.1093/eurheartj/ehaa575

7. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal. 2020;41 (3):407–77. DOI: 10.1093/eurheartj/ehz425

8. Neumann F-J, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U et al. 2018 ESC / EACTS Guidelines on myocardial revascularization. European Heart Journal. 2019;40 (2):87–165. DOI: 10.1093/eurheartj/ehy394

9. Gulizia MM, Colivicchi F, Abrignani MG, Ambrosetti M, Aspromonte N, Barile G et al. Consensus Document ANMCO / ANCE / ARCA / GICR-IACPR / GISE / SICOA: Long-term Antiplatelet Therapy in Patients with Coronary Artery Disease. European Heart Journal Supplements. 2018;20 (Suppl F): F1–74. DOI: 10.1093/eurheartj/suy019

10. Gusev A. V., Zarubina T. V. Clinical Decisions Support in medical information systems of a medical organization. Physician and information technology. 2017;2:60–72.

11. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M et al. The Global Health and Economic Burden of Hospitalizations for Heart Failure. Journal of the American College of Cardiology. 2014;63 (12):1123–33. DOI: 10.1016/j.jacc.2013.11.053

12. Posnenkova O. M., Genkal E. N., Popova Yu. V., Kiselev A. R., Gridnev V. I. Application of information technologies for selection of treatment strategy in patients with stable coronary artery disease. Cardiо-IT. 2019;6 (2):e0201. DOI: 10.15275/cardioit.2019.0201

13. Mukhopadhyay A, Reynolds HR, Xia Y, Phillips LM, Aminian R, Diah R-A et al. Design and pilot implementation for the BETTER CAREHF trial: A pragmatic cluster-randomized controlled trial comparing two targeted approaches to ambulatory clinical decision support for cardiologists. American Heart Journal. 2023;258:38–48. DOI: 10.1016/j.ahj.2022.12.016

14. Losik D. V., Kozlova S. N., Krivosheev Yu. S., Ponomarenko A. V., Ponomarev D. N., Pokushalov E. A. et al. Retrospective analysis of clinical decision support system use in patients with hypertension and atrial fibrillation (INTELLECT). Russian Journal of Cardiology. 2021;26 (4):54–60. DOI: 10.15829/1560-4071-2021-4406

15. Ponomarenko A. V., Krivosheev Yu. S., Mikheenko I. L., Sorokin E. V., Sapelnikov O. V., Paleyev F. N. et al. Searching for potential factors associated with failed catheter ablation of atrial fibrillation. Retrospective analysis of electronic medical records using medical decision making support service (SELECT AF study). Russian Cardiology Bulletin. 2023;18 (2):35–42. DOI: 10.17116/Cardiobulletin20231802135

16. Kukharchuk V. V., Ezhov M. V., Sergienko I. V., Arabidze G. G., Bubnova M. G., Balakhonova T. V. et al. Diagnostics and correction of lipid metabolism disorders in order to prevent and treat of atherosclerosis Russian recommendations VII revision. Atherosclerosis and dyslipidemia. 2020;1 (38):7–40. DOI: 10.34687/2219–8202.JAD.2020.01.0002

17. Barbarash O. L., Karpov Yu. A., Kashtalap V. V., Boshchenko A. A., Ruda M. Ya., Akchurin R. S. et al. 2020 Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2020;25 (11):201–50. DOI: 10.15829/1560-4071-2020-4076

18. Averkov O. V., Duplyakov D. V., Gilyarov M. Yu., Novikova N. A., Shakhnovich R. M., Yakovlev A. N. et al. 2020 Clinical practice guidelines for Acute ST-segment elevation myocardial infarction. Russian Journal of Cardiology. 2020;25 (11):251–310. DOI: 10.15829/29/1560-4071-2020-4103

19. Taylor F, Huffman MD, Macedo AF, Moore TH, Burke M, Davey Smith G et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews. 2013;2021 (9):CD004816. DOI: 10.1002/14651858.CD004816.pub5

20. Schubert J, Lindahl B, Melhus H, Renlund H, Leosdottir M, Yari A et al. Low-density lipoprotein cholesterol reduction and statin intensity in myocardial infarction patients and major adverse outcomes: a Swedish nationwide cohort study. European Heart Journal. 2021;42 (3):243–52. DOI: 10.1093/eurheartj/ehaa1011

21. McKie PM, Kor DJ, Cook DA, Kessler ME, Carter RE, Wilson PM et al. Computerized Advisory Decision Support for Cardiovascular Diseases in Primary Care: A Cluster Randomized Trial. The American Journal of Medicine. 2020;133 (6):750–756.e2. DOI: 10.1016/j.amjmed.2019.10.039

22. Ozaki AF, Jackevicius CA, Chong A, Sud M, Fang J, Austin PC et al. Hospital‐Level Variation in Ticagrelor Use in Patients With Acute Coronary Syndrome. Journal of the American Heart Association. 2022;11 (13):e024835. DOI: 10.1161/JAHA.121.024835

23. Orenes-Piñero E, Esteve-Pastor MA, Ruiz-Nodar JM, Quintana-Giner M, Veliz-Martínez A, Tello-Montoliú A et al. Under-prescription of novel antiplatelet drugs in patients with acute coronary syndrome and previous cardiovascular disease. Minerva Medica. 2019;110 (5):410–8. DOI: 10.23736/S0026–4806.19.05859–2

24. Ulvenstam A, Henriksson R, Söderström L, Mooe T. Ischemic stroke rates decrease with increased ticagrelor use after acute myocardial infarction in patients treated with percutaneous coronary intervention. European Journal of Preventive Cardiology. 2018;25 (11):1219–30. DOI: 10.1177/2047487318784082

25. Steffel J, Eikelboom JW, Anand SS, Shestakovska O, Yusuf S, Fox KAA. The COMPASS Trial: Net Clinical Benefit of Low-Dose Rivaroxaban Plus Aspirin as Compared With Aspirin in Patients With Chronic Vascular Disease. Circulation. 2020;142 (1):40–8. DOI: 10.1161/CIRCULATIONAHA.120.046048

26. Gielen S. Prolonged dual antiplatelet therapy: Has PEGASUS landed in the real world? European Journal of Preventive Cardiology. 2020;27 (7):693–5. DOI: 10.1177/2047487319872631

27. Szymański P, Weidinger F, Lordereau-Richard I, Himmelmann A, Arca M, Chaves J et al. Real world evidence: Perspectives from a European Society of Cardiology Cardiovascular Round Table with contribution from the European Medicines Agency. European Heart Journal – Quality of Care and Clinical Outcomes. 2023;9 (2):109–18. DOI: 10.1093/ehjqcco/qcad009

28. Mukhopadhyay A, Reynolds HR, Phillips LM, Nagler AR, King WC, Szerencsy A et al. Cluster-Randomized Trial Comparing Ambulatory Decision Support Tools to Improve Heart Failure Care. Journal of the American College of Cardiology. 2023;81 (14):1303–16. DOI: 10.1016/j.jacc.2023.02.005

29. Redón J, Usó R, Trillo JL, López C, Morales-Olivas F, Navarro J et al. Number of drugs used in secondary cardiovascular prevention and late survival in the population of Valencia Community, Spain. International Journal of Cardiology. 2019;293:260–5. DOI: 10.1016/j.ijcard.2019.05.071