Abstract 14008: Individualized Risk Communication and Lay Outreach for the Primary Prevention of Cardiovascular Disease in Community Health Centers: a Randomized Controlled Trial
Introduction: Many primary cardiovascular disease (CVD) prevention candidates are not treated with statins. We conducted a pragmatic randomized controlled trial at three federally qualified health center networks in 2 states to evaluate a population health management intervention.
Methods: Patients identified using electronic health records (EHR) were randomized to immediate or 1-year delayed outreach with a waiver of consent. Men ≥35 and women ≥45 years old with 10-year hard coronary Framingham Risk Score (FRS) of ≥10%, LDL-C ≥ 100 mg/dl, no prescribed statin and no diagnosed CVD or diabetes were included. The intervention was a mailing with patients’ individualized risk and phone outreach by non-clinician care managers who encouraged patients to schedule a CVD prevention visit. This was repeated if no visit occurred in 3 months. The primary outcome was a cholesterol treatment discussion with a clinician within 6 months by blinded chart review. Secondary outcomes were statin prescribing, and LDL-C (or non-HDL-C) reduction of at least 30 mg/dl at 1 year.
Results: 646 patients were included. The mean age was 60.5 years, 88% were male, and 55% were current smokers. Mean FRS was 15%, total cholesterol 212 mg/dl, LDL cholesterol 133 mg/dl. At 6 months, 26.5% of intervention and 10.4% of control patients had discussed cholesterol treatment with a primary care provider (RR 3.1, 95% CI 2.0-4.8), and statin prescribing was higher (10.1% vs. 5.0%, RR 2.1, CI 1.1-3.9). Cholesterol outcomes did not differ but few patients repeated lipid levels after a new prescription.
Conclusions: In conclusion, risk communication and lay outreach to primary prevention candidates increased cholesterol treatment discussions, but the majority of discussions did not result in statin prescribing. Physician reluctance to prescribe, patient reluctance to take medication, or too great an emphasis on cholesterol levels rather than risk are potential explanations for these findings.
Author Disclosures: S.D. Persell: Employment; Significant; Northwestern Memorial Health Care, Northwestern University. Research Grant; Significant; NIH, AHRQ, Pfizer, HRSA. Consultant/Advisory Board; Significant; American Board of Internal Medicine. S. Shah: None. T. Brown: None. J. Lee: None. T. Sanchez: None. R.G. Knight: None. E. Kaleba: None. M. Jean-Jacques: None. N.R. Kandula: None. E. Henley: None. T. Long: None. S. Luther: None.
- © 2014 by American Heart Association, Inc.