The role of Decision Support System (DSS) in prevention of cardiovascular disease: a systematic review and meta-analysis.
BACKGROUND
The potential role of DSS in CVD prevention remains unclear as only a few studies report on patient outcomes for cardiovascular disease.


RESULTS
A systematic review and meta-analysis of randomised controlled trials and observational studies was done using Medline, Embase, Cochrane Library, PubMed, Amed, CINAHL, Web of Science, Scopus databases; reference lists of relevant studies to 30 July 2011; and email contact with experts. The primary outcome was prevention of cardiovascular disorders (myocardial infarction, stroke, coronary heart disease, peripheral vascular disorders and heart failure) and management of hypertension owing to decision support systems, clinical decision supports systems, computerized decision support systems, clinical decision making tools and medical decision making (interventions). From 4116 references ten studies met our inclusion criteria (including 16,312 participants). Five papers reported outcomes on blood pressure management, one paper on heart failure, two papers each on stroke, and coronary heart disease. The pooled estimate for CDSS versus control group differences in SBP (mm of Hg) was - 0.99 (95% CI -3.02 to 1.04 mm of Hg; I(2) = 0; p = 0.851).


CONCLUSIONS
DSS show an insignificant benefit in the management and control of hypertension (insignificant reduction of SBP). The paucity of well-designed studies on patient related outcomes is a major hindrance that restricts interpretation for evaluating the role of DSS in secondary prevention. Future studies on DSS should (1) evaluate both physician performance and patient outcome measures (2) integrate into the routine clinical workflow with a provision for decision support at the point of care.
Department of Public Health & Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge, United Kingdom.
Raghupathy
R
Anchala
Maria P
MP
Pinto
Amir
A
Shroufi
Rajiv
R
Chowdhury
Jean
J
Sanderson
Laura
L
Johnson
Patricia
P
Blanco
Dorairaj
D
Prabhakaran
Oscar H
OH
Franco
D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003324:Coronary Artery Disease / Q000517:prevention & control; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000517:prevention & control / Q000628:therapy; D009203:Myocardial Infarction / Q000517:prevention & control