Document Type

Article

Publication Date

6-16-2026

Comments

This article is the author’s final published version in Journal of the American Heart Association, Volume 15, Issue 12, 2026, Article number e047116.

The published version is available at https://doi.org/10.1161/JAHA.125.047116. Copyright © 2026 The Author(s).

 

Abstract

BACKGROUND: This observational, quality initiative evaluated the impact of changing from a passive (dismissible) to an active (nondismissible without action) electronic health record alert on guideline-recommended lipid-lowering therapy (LLT) prescriptions in patients with recent myocardial infarction at risk for secondary events.

METHODS: We sequentially recruited a retrospective passive-alert (February 2018-July 2019; n=733) and a prospective active-alert (August 2020-January 2022; n=587) cohort of patients who triggered an alert to intensify LLT or order a low-density lipoprotein-cholesterol (LDL-C) test if they had a recent myocardial infarction (within 12 months) and elevated (≥70 mg/dL) or missing LDL-C. Prescribed LLTs and cumulative percentages of patients with missing or LDL-C < 70 and < 55 mg/dL were assessed in 6-month periods up to 24 months. Reasons for not intensifying LLTs were recorded with the active alert.

RESULTS: During 24 months, statin and high-intensity statin use increased from 59% to 87% and from 39% to 69%, respectively, in the passive-alert cohort. In the active-alert cohort, statin and high-intensity statin use were high and changed minimally (79% to 80% and 70% to 73%), but ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitor use increased from 12% to 35% and from 2% to 8% (odds ratio, 4.69 [95% CI, 3.22-6.96] and 4.07 [95% CI, 1.92-9.46]), respectively. LDL-C testing and LDL-C goal attainment improved in both cohorts. LDL-C not current (41.7%) was the most common reason for not intensifying LLT.

CONCLUSIONS: Continued efforts are needed to encourage guideline-directed LLT intensification for patients with a recent myocardial infarction who are at risk of another cardiac event.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Additional Files
Tables and Figures.pdf (2384 kB)
STROBE Checklist.pdf (204 kB)

Language

English

PubMed ID

42261954

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