The impact of clinical decision support systems on adherence to clinical guidelines and achieving target levels of low-density lipoprotein cholesterol in patients at risk of developing cardiovascular events (SuccESS)

Aim. To assess the effectiveness of clinical decision support system (CDSS) implementation strategy in increasing the frequency of low-density lipoprotein cholesterol (LDL-С) monitoring in patients hospitalized for acute cardiovascular events (CVEs), in patients with coronary artery disease (CAD) or dyslipidemia. Material and methods. A non-interventional, retrospective, multicentre study assessing the impact of a CDSS with automatic electronic medical record (EMR) data processing on adherence to guidelines in patients at risk of cardiovascular diseases (SuccESS) was performed. The study included two cohorts of patients from healthcare facilities in three regions of Russia. The main cohort consisted of patients hospitalized for acute CVEs, with 12,227 patients included in the first follow-up period and 11,364 patients included in the second follow-up period. The additional cohort consisted of patients with stable CAD or dyslipidemia, with 54 469 patients included in the first follow-up period and 94,616 patients included in the second follow-up period. The study assessed follow-up findings in real-world clinical practice before and after the CDSS was implemented (first and second follow-up periods, respectively). The median duration of follow-up in the main cohort was >158 days in the first follow-up period and >227 days in the second follow-up period. Results. In the second follow-up period the proportion of patients with available data on LDL-C control in the EMR increased from 12.3% to 18.8% (here and further — relative change: +52.3%, p<0.001) in the main cohort and from 12.3% to 19.8% (+61.7%, p<0.001) in the additional cohort. The proportion of patients with myocardial infarction and unstable angina in the main cohort who did not visit a general practitioner or cardiologist during the follow-up period decreased from 33.1% to 25.5% (-23%, p<0.001). The proportion of patients with ischemic stroke and transient ischemic attack (TIA) in the main cohort who did not visit a general practitioner or neurologist during the follow-up period decreased from 66.6% to 39.3% (-41%, p<0.001). In the additional cohort, the proportion of patients who did not visit a general practitioner or cardiologist decreased from 38.2% to 27.6% (-28%, p<0.001). The use of low-intensity/moderate-intensity statin therapy decreased from 12.5% to 9% (-27%, p<0.001) in the main cohort and from 47.4% to 40% (-15%, p<0.001) in the additional cohort. However, the use of high-intensity statin therapy in the additional cohort increased from 42.7% to 49.9% (+17%). In the second follow-up period, there was a decrease in the number of hospitalizations for myocardial infarction and ischemic stroke from 3.6% to 1.7% (-53%, p<0.001) in the main cohort and from 0.1% to 0.06% (-40%, p=0.01) in the additional cohort. Conclusion. The study findings demonstrate the positive impact of CDSS on several parameters that determine the quality and organization of medical care. The CDSS can be used to improve clinical and managerial decisions.