Background: Despite clear and concise practice guidelines, strategies for lowering LDL-C are often poorly adopted in clinical practice, and many patients fail to reach guideline-recommended levels despite physician education and quality improvement programs. We studied whether physician focussed, guideline-based practice level educational intervention can improve lipid lowering management.

Methods: Cardiologists or internal medicine specialists from the province of Ontario, Canada who were using a cardiology specific EMR (CEREBRUM, WELL Health Technologies Corporation) were invited to participate. Practice level data of patients with history of acute coronary syndromes (ACS) and lipid profile were studied. Physicians were alerted when patients in their practice were not treated according to recommendations. The primary endpoint was proportion of patients achieving the recommended LDL-C level of below 1.8 mmol/L.

Results: Of the invited 378 specialists, 178 agreed to participate and shared their practice involving 7,683 ACS patients who were 70.4 ± 10.3 years of age and 27.2% were women. Overall, 57.7% of patients had LDL-C < 1.8 mmol/L at the start of the program (1.84 ± 0.87 mmol/L) and 63.0% (1.75 ± 0.79 mmol/L) at the end of the program (p<0.0001). With respect to the lipid lowering therapy, statin therapy was used in 52.9% of patients at the start of the program and increased to 72.1% at the end (p<0.0001). The use of ezetimibe increased from 12.6% to 19.0% (p<0.0001) and the use of PCSK9i from 1.2% to 2.4% (p<0.0001).

Conclusion: The results indicate the feasibility of using EMR as a platform to deliver educational intervention and overcoming treatment inertia and improving LDL-C lowering.