Multisite Investigation of Strategies for the Implementation of CYP2C19 Genotype-Guided Antiplatelet Therapy

Abstract

CYP2C19 genotype-guided antiplatelet therapy following percutaneous coronary intervention is increasingly implemented in clinical practice. However, challenges such as selecting a testing platform, communicating test results, building clinical decision support processes, providing patient and provider education, and integrating methods to support the translation of emerging evidence to clinical practice are barriers to broad adoption. In this report, we compare and contrast implementation strategies of 12 early adopters, describing solutions to common problems and initial performance metrics for each program. Key differences between programs included the test result turnaround time and timing of therapy changes, which are both related to the CYP2C19 testing model and platform used. Sites reported the need for new informatics infrastructure, expert clinicians such as pharmacists to interpret results, physician champions, and ongoing education. Consensus lessons learned are presented to provide a path forward for those seeking to implement similar clinical pharmacogenomics programs within their institutions.

Figure 1. Modalities of communication and education

Approaches for providers and patients that were reported by sites are listed in order of decreasing scalability.

Figure 2. Proportion of patients carrying nonfunctional alleles on alternative (ALT) therapy at discharge and first follow-up

Sites using standard (single gene- and panel- based testing with >1 day TAT) and rapid (right panel) testing are grouped in the left and right panels, respectively. Tables below indicate number of patients in each group. * p < 0.0001 by Chi-square.