Stories

Web-based tool may reduce heart disease risk among health center patients, study finds

Stories - March 11, 2022

The use of a clinical decision support system (CDSS) linked to electronic health records shows promise in reducing the risk of heart disease — the leading cause of death in adults in the United States — among patients who receive primary care at community health centers, according to a recent study.

The study examined the effectiveness of CV Wizard, a CDSS that both provides clinical decision support and enables shared decision-making related to cardiovascular disease (CVD) risk factor management, in community clinic settings. Study results showed that consistent use of CV Wizard was associated with significantly decreased reversible CVD risk among patients at the highest level of risk.

The cluster-randomized trial was conducted by Kaiser Permanente Center for Health Research (CHR) and the community care-focused network OCHIN, both based in Portland, and HealthPartners Institute, the research and education arm of HealthPartners, a care delivery system that includes hospitals, clinics, and a health plan, based in Minnesota.

Results were published Feb. 4, 2022, in the American Medical Association’s open-access medical journal, JAMA Network Open. The lead author was Rachel Gold, PhD, MPH, a CHR senior investigator and lead research scientist at OCHIN.

Study results indicate that use of CV Wizard may improve CVD risk management among community health center patients at high risk of developing heart disease.

“The use of this CDSS and shared decision-making tools shows promise in preventing cardiovascular disease in patients who receive their health care in traditionally under-resourced centers,” Gold said.

More than 18,500 patients at 70 community health center clinics located nationwide were included in the trial, which ran from September 2018 to March 2020. Participants, ranging from 40 to 75 years old, had diabetes or atherosclerotic CVD and one or more uncontrolled major CVD risk factor, or at least a 10% modifiable (reversible) risk of having a CVD event (heart attack, stroke) in the following 10 years. Thirty-five percent were non-Hispanic white, 25% were Hispanic, and 21% were non-Hispanic Black.

CV Wizard, developed at HealthPartners Institute, has been shown to be effective in integrated care settings serving primarily insured patients. Its algorithms use data from electronic health records — data such as  blood pressure values, laboratory results, distance from CVD and diabetes risk management goals, current medications, and diagnosis codes — to calculate CVD risk and provide care suggestions individualized for a given patient.

Despite the promising findings, the CDSS had “low use rates.” A commentary on trial results noted that the CV Wizard shared decision-making tools were used at only 20% of eligible  community health center visits.

“Given that the intervention was an automated EHR alert containing the CV Wizard link provided to rooming staff, and that simply viewing the information was counted as CDSS use, this means that 80% of alerts were left unheeded,” the commentary said. “Why this occurred in CHCs but not in better-resourced health care facilities where CV Wizard rates of use have been closer to 70% to 80% is unclear but critical to understand.”

The manuscript points out that the higher adoption rates occurred in centralized care systems with established tool use workflows, whereas the community-based study clinics included numerous care organizations, with heterogeneity in rooming protocols, and whose patients are often more medically and socially complex than at other care settings.

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Heart disease results from a buildup of plaque in arteries that limits the flow of blood. Top risk factors are high blood pressure, high blood cholesterol and smoking. Conditions and lifestyle choices that result in diabetes, being overweight, an unhealthy diet, physical inactivity and excessive alcohol use also contribute to cardiovascular risk. For more information, visit the Centers for Disease Control or American Heart Association website.