Randomized trial of a computerized coronary heart disease risk assessment tool in HIV-infected patients receiving combination antiretroviral therapy.
BACKGROUND
Exposure to combination antiretroviral therapy (cART) can lead to important metabolic changes and increased risk of coronary heart disease (CHD). Computerized clinical decision support systems have been advocated to improve the management of patients at risk for CHD but it is unclear whether such systems reduce patients' risk for CHD.


METHODS
We conducted a cluster trial within the Swiss HIV Cohort Study (SHCS) of HIV-infected patients, aged 18 years or older, not pregnant and receiving cART for >3 months. We randomized 165 physicians to either guidelines for CHD risk factor management alone or guidelines plus CHD risk profiles. Risk profiles included the Framingham risk score, CHD drug prescriptions and CHD events based on biannual assessments, and were continuously updated by the SHCS data centre and integrated into patient charts by study nurses. Outcome measures were total cholesterol, systolic and diastolic blood pressure and Framingham risk score.


RESULTS
A total of 3,266 patients (80% of those eligible) had a final assessment of the primary outcome at least 12 months after the start of the trial. Mean (95% confidence interval) patient differences where physicians received CHD risk profiles and guidelines, rather than guidelines alone, were total cholesterol -0.02 mmol/l (-0.09-0.06), systolic blood pressure -0.4 mmHg (-1.6-0.8), diastolic blood pressure -0.4 mmHg (-1.5-0.7) and Framingham 10-year risk score -0.2% (-0.5-0.1).


CONCLUSIONS
Systemic computerized routine provision of CHD risk profiles in addition to guidelines does not significantly improve risk factors for CHD in patients on cART.
Bucher
Heiner C
HC
Basel Institute for Clinical Epidemiology & Biostatistics, Basel, Switzerland. hbucher@uhbs.ch
Rickenbach
Martin
M
Young
Jim
J
Glass
Tracy R
TR
Vallet
Yannick
Y
Bernasconi
Enos
E
Cavassini
Matthias
M
Fux
Christoph
C
Schiffer
Véronique
V
Vernazza
Pietro
P
Weber
Rainer
R
Battegay
Manuel
M
D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects*; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003198:Computer Simulation; D003327:Coronary Disease / Q000139:chemically induced / Q000453:epidemiology*; D004359:Drug Therapy, Combination / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors
D044966:Anti-Retroviral Agents; D002784:Cholesterol