Severe hypercholesterolemia/possible familial hypercholesterolemia (FH) is relatively common but underdiagnosed and undertreated. We investigated whether implementing clinical decision support (CDS) was associated with lower low-density lipoprotein cholesterol (LDL-C) in patients with severe hypercholesterolemia/possible FH (LDL-C ≥ 190 mg/dL). As part of a pre-post implementation study, a CDS alert was deployed in the electronic health record (EHR) in a large health system comprising 3 main sites, 16 hospitals and 53 clinics. Data were collected for 3 months before (‘silent mode’) and after (‘active mode’) its implementation. Clinicians were only able to view the alert in the EHR during active mode. We matched individuals 1:1 in both modes, based on age, sex, and baseline lipid lowering therapy (LLT). The primary outcome was difference in LDL-C between the two groups and the secondary outcome was initiation/intensification of LLT after alert trigger. We identified 800 matched patients in each mode (mean ± SD age 56.1 ± 11.8 y vs. 55.9 ± 11.8 y; 36.0% male in both groups; mean ± SD initial LDL-C 211.3 ± 27.4 mg/dL vs. 209.8 ± 23.9 mg/dL; 11.2% on LLT at baseline in each group). LDL-C levels were 6.6 mg/dL lower (95% CI, −10.7 to −2.5; P = 0.002) in active vs. silent mode. The odds of high-intensity statin use (OR, 1.78; 95% CI, 1.41–2.23; P < 0.001) and LLT initiation/intensification (OR, 1.30, 95% CI, 1.06–1.58, P = 0.01) were higher in active vs. silent mode. Implementation of a CDS was associated with lowering of LDL-C levels in patients with severe hypercholesterolemia/possible FH, likely due to higher rates of clinician led LLT initiation/intensification.

严重高胆固醇血症/可能的家族性高胆固醇血症（FH）相对常见，但诊断和治疗不足。我们研究了实施临床决策支持 (CDS) 是否与重度高胆固醇血症/可能 FH（LDL-C ≥ 190 mg/dL）患者的低密度脂蛋白胆固醇（LDL-C）降低相关。作为实施前后研究的一部分，CDS 警报被部署在由 3 个主要站点、16 家医院和 53 家诊所组成的大型卫生系统的电子健康记录 (EHR) 中。数据收集于实施前（“静默模式”）和实施后（“主动模式”）3 个月。临床医生只能在主动模式下查看 EHR 中的警报。我们根据年龄、性别和基线降脂治疗 (LLT) 在两种模式下对个体进行 1:1 匹配。主要结局是两组之间 LDL-C 的差异，次要结局是警报触发后 LLT 的启动/强化。我们在每种模式下确定了 800 名匹配的患者（平均±SD 年龄 56.1 ± 11.8 岁 vs. 55.9 ± 11.8 岁；两组均为 36.0% 男性；平均±SD 初始 LDL-C 211.3 ± 27.4 mg/dL vs. 209.8 ± 23.9 mg /dL；每组基线时 LLT 为 11.2%）。 与静默模式相比，主动模式下的LDL-C 水平降低了 6.6 mg/dL（95% CI，-10.7 至 -2.5；P = 0.002）。高强度他汀类药物使用（OR，1.78；95% CI，1.41–2.23；P  < 0.001）和 LLT 开始/强化（OR，1.30，95% CI，1.06–1.58，P  = 0.01）的几率较高主动模式与静音模式。CDS 的实施与严重高胆固醇血症/可能 FH 患者的 LDL-C 水平降低相关，这可能是由于临床医生主导的 LLT 启动/强化率较高。