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Heart Health

16 October 2020

Computer 'nudge' spurs doctors to prescribe statins to heart patients

A new study found that among doctors who received active nudges, there was a four percentage point increase in optimal statin prescribing in patients with heart disease.

  • In a study, doctors randomly received 'nudges' to prescribe statins in their patients' electronic health records
  • The nudges flagged patients with heart disease or those who were at risk for it
  • Statin therapy can reduce major adverse cardiovascular events like heart attacks


Prescriptions of cholesterol-lowering statins for heart disease patients rose significantly when doctors were prompted to choose whether or not to order them, according to a new study.

It included 82 cardiologists and more than 11 000 patients. Doctors randomly received one of two "nudges", or notifications, in their patients' electronic health records.

One was a "passive choice" notification to which doctors would navigate. The other was an "active choice" notification to prescribe a certain dose of statins that doctors needed to accept or dismiss.

The nudges flagged patients with heart disease or those who were at risk for it. Each nudge also suggested the best dose of statins based on patients' information.

Active choice prompts

Some doctors didn't receive any nudge and acted as a control group in the six-month study.

Among doctors who received active nudges, there was a four percentage point increase in optimal statin prescribing in patients with heart disease, according to the University of Pennsylvania School of Medicine study.

However, there was no significant difference in prescribing rates for those patients at risk of heart disease but did not yet have it.

"Active choice prompts are used commonly in electronic health records, but they often are not rigorously tested head-to-head against other approaches," said senior author Dr Mitesh Patel, director of Penn Medicine's Nudge Unit.

Reduction in cardiovascular events

"By systematically testing these interventions we can build upon the approaches that do work and turn off the ones that don't," he said in a university news release.

First author Dr Srinath Adusumalli said active choice prompts led to small increases in prescribing statins for patients at highest risk – those who already had plaque buildup in their arteries.

"These are the types of patients who stand to benefit the most from statin therapy with regard to reduction in major adverse cardiovascular events, like a heart attack, and mortality," said Adusumalli, an assistant professor of cardiovascular medicine.

The study findings were published in the journal JAMA Cardiology.

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