Journal of General Internal Medicine

, Volume 28, Issue 4, pp 554–560

Electronic Health Record-Based Patient Identification and Individualized Mailed Outreach for Primary Cardiovascular Disease Prevention: A Cluster Randomized Trial

  • Stephen D. Persell
  • Donald M. Lloyd-Jones
  • Elisha M. Friesema
  • Andrew J. Cooper
  • David W. Baker
Original Research



Many individuals at higher risk for cardiovascular disease (CVD) do not receive recommended treatments. Prior interventions using personalized risk information to promote prevention did not test clinic-wide effectiveness.


To perform a 9-month cluster-randomized trial, comparing a strategy of electronic health record-based identification of patients with increased CVD risk and individualized mailed outreach to usual care.


Patients of participating physicians with a Framingham Risk Score of at least 5 %, low-density lipoprotein (LDL)-cholesterol level above guideline threshold for drug treatment, and not prescribed a lipid-lowering medication were included in the intention-to-treat analysis.


Patients of physicians randomized to the intervention group were mailed individualized CVD risk messages that described benefits of using a statin (and controlling hypertension or quitting smoking when relevant).


The primary outcome was occurrence of a LDL-cholesterol level, repeated in routine practice, that was at least 30 mg/dl lower than prior. A secondary outcome was lipid-lowering drug prescribing. identifier: NCT01286311.


Fourteen physicians with 218 patients were randomized to intervention, and 15 physicians with 217 patients to control. The mean patient age was 60.7 years and 77% were male. There was no difference in the primary outcome (11.0 % vs. 11.1 %, OR 0.99, 95 % CI 0.56–1.74, P = 0.96), but intervention group patients were twice as likely to receive a prescription for lipid-lowering medication (11.9 %, vs. 6.0 %, OR 2.13, 95 % CI 1.05–4.32, p = 0.038). In post hoc analysis with extended follow-up to 18 months, the primary outcome occurred more often in the intervention group (22.5 % vs. 16.1 %, OR 1.59, 95 % CI 1.05–2.41, P = 0.029).


In this effectiveness trial, individualized mailed CVD risk messages increased the frequency of new lipid-lowering drug prescriptions, but we observed no difference in proportions lowering LDL-cholesterol after 9 months. With longer follow-up, the intervention’s effect on LDL-cholesterol levels was apparent.


cholesterol primary care cardiovascular disease prevention electronic health records patient outreach 

Supplementary material

11606_2012_2268_MOESM1_ESM.pdf (234 kb)
ESM 1(PDF 233 kb)


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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Stephen D. Persell
    • 1
    • 2
  • Donald M. Lloyd-Jones
    • 3
    • 4
  • Elisha M. Friesema
    • 1
  • Andrew J. Cooper
    • 1
  • David W. Baker
    • 1
    • 2
  1. 1.Division of General Internal Medicine and Geriatrics, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  2. 2.Institute for Health Care Studies, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  3. 3.Division of Cardiology, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  4. 4.Department of Preventive Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoUSA

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