title: Providing clinicians with a patient's 10-year cardiovascular risk improves their statin prescribing: a true experiment using clinical vignettes.
abstract: BACKGROUND
  Statins are effective for primary prevention of cardiovascular (CV) disease, the leading cause of death in the world. Multinational guidelines emphasize CV risk as an important factor for optimal statin prescribing. However, it's not clear how primary care providers (PCPs) use this information. The objective of this study was to determine how primary care providers use information about global CV risk for primary prevention of CV disease.
  
  
  METHODS
  A double-blinded, randomized experiment using clinical vignettes mailed to office-based PCPs in the United States who were identified through the American Medical Association Physician Masterfile in June 2012. PCPs in the control group received clinical vignettes with all information on the risk factors needed to calculate CV risk. The experimental group received the same vignettes in addition to the subject's 10-year calculated CV risk (Framingham risk score). The primary study outcome was the decision to prescribe a statin.
  
  
  RESULTS
  Providing calculated CV risk to providers increased statin prescribing in the two high-risk cases (CV risk > 20%) by 32 percentage points (41% v. 73%; 95% CI = 23-40, p <0.001; relative risk [RR] = 1.78) and 16 percentage points (12% v. 27%, 95% CI 8.5-22.5%, p <0.001; RR = 2.25), and decreased statin prescribing in the lowest risk case (CV risk = 2% risk) by 9 percentage points [95% CI = 1.00-16.7%, p = 0.003, RR = 0.88]. Fewer than 20% of participants in each group reported routinely calculating 10-year CV risk in their patients.
  
  
  CONCLUSIONS
  Providers do not routinely calculate 10-year CV risk for their patients. In this vignette experiment, PCPs undertreated low LDL, high CV risk patients. Giving providers a patient's calculated CV risk improved statin prescribing. Providing PCPs with accurate estimates of patient CV risk at the point of service has the potential to improve the efficiency of statin prescribing.
authors.affiliation: Division of General Internal Medicine, University of Michigan Medical School & VA Ann Arbor Healthcare System, 3119 Taubman Center, 1500 East Medical Center Drive, 48109-5604 Ann Arbor, MI, USA. nishants@umich.edu.
authors.forename: Nishant K
authors.initials: NK
authors.lastname: Sekaran
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Sussman
authors.forename: Anna
authors.initials: A
authors.lastname: Xu
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Hayward
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology; D003625:Data Collection / Q000639:trends*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000592:standards / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends*; D012307:Risk Factors; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors