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. 2024 Nov 23:21:100895.
doi: 10.1016/j.ajpc.2024.100895. eCollection 2025 Mar.

Increasing provider awareness of Lp(a) testing for patients at risk for cardiovascular disease: A comparative study

Wael E Eid  1   2   3   4 , Emma Hatfield Sapp  5 , Callen Conroy  6 , Coby Bessinger  6 , Cassidy L Moody  6 , Ryan Yadav  6 , Reece Tolliver  7 , Joseph Nolan  7 , Suzanne M Francis  5
Affiliations

Increasing provider awareness of Lp(a) testing for patients at risk for cardiovascular disease: A comparative study

Wael E Eid et al. Am J Prev Cardiol. .

Abstract

Background: Lipoprotein(a) [Lp(a)] is a low-density lipoprotein variant with atherogenic, thrombogenic, and pro-inflammatory properties that may have numerous pathologic effects, including dyslipidemia. Screening for Lp(a) is clinically significant, due to its causal role in atherosclerotic cardiovascular disease (ASCVD). Among clinicians, however, there remains a general lack of both clinical awareness of Lp(a) and adequate tools to track Lp(a) testing in patients.

Objective: To study factors affecting Lp(a) screening by: i) determining the effectiveness of messaging providers at a large community health system about Lp(a) screening and measuring the subsequent percentage of Lp(a) tests requested; and ii) by determining the percentage of patients who obtained Lp(a) testing after being advised by the provider.

Methods: From December 2022 through March 2023, messages detailing the need for Lp(a) screening were sent via the Epic EHR™ to providers of patients meeting criteria for Lp(a) testing in advance of scheduled patient appointments. In this prospective study, providers were randomized into 2 groups: those receiving the pre-appointment message (Group 1) and those not receiving the pre-appointment message (Group 2).

Results: Sending pre-appointment messages correlated with more Lp(a) orders (16.6 % v. 4.7 %, P < 0.001) and consequently with more tests performed (10.2 % v. 3.7 %, p < 0.001). Among provider types, nurse practitioners and physician assistants had the highest number of Lp(a) results per order (Z = 16.40, P < 0.001), achieving 30.8-39.1 % more test results, even if they did not receive the pre-appointment message. Distribution of Lp(a) values in patients was 59.7 % ≤ 29 mg/dL; 9.7 % > 29 and < 50mg/dL; and 30.6 % ≥ 50 mg/dL.

Conclusion: Providers who received pre-appointment messages via an EHR were associated with requesting more tests and consequently receiving more Lp(a) results, compared with providers who did not receive messages.

Keywords: ASCVD; CVD risk screening; Electronic Health Record (EHR); Lp(a); atherosclerosis; cardiovascular disease; cholesterol; implementation science; lipoprotein(a); patient consultation; proactive provider messaging.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image, graphical abstract
Graphical abstract
Fig. 1
Fig. 1
Distribution of patients meeting Lp(a) testing criteria in a healthcare population in northern Kentucky.
Fig. 2
Fig. 2
Standardized provider staff message.
Fig. 3
Fig. 3
Lp(a) Tests requested by specialty provider (n = 585).
Fig. 4
Fig. 4
Lp(a) Results by specialty provider and whether message sent or not.
Fig. 5
Fig. 5
Lp(a) Results by Lp(a) level and study group.
Fig. 6
Fig. 6
Median Lp(a) in different studied comorbidities.
See this image and copyright information in PMC

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