J Am Pharm Assoc (2003). 2026 Mar 20:103081. doi: 10.1016/j.japh.2026.103081. Online ahead of print.
ABSTRACT
BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death for patients with type 2 diabetes (T2D). Recent clinical guidelines recommend earlier initiation of glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with ASCVD, chronic kidney disease, and/or multiple risk factors. However, broader adoption among healthcare clinicians has been evolving, influenced by factors such as medication cost, clinical complexity, and established care pathways that may involve specialist management. While interruptive and non-interruptive clinical decision support (CDS) within electronic health records (EHRs) can help identify care gaps, their specific impact on prescribing these cardioprotective agents is not well defined.
OBJECTIVE: This pilot study evaluated the use of CDS during specialist visits to facilitate guideline-directed medical therapy (GDMT) for patients with T2D and ASCVD in primary care.
METHODS: We conducted a retrospective, single-center cohort study at a large academic medical center to assess an interruptive alert presented during interventional cardiology (IC) visits. When the IC clinician acknowledged the alert, an automated EHR message was sent to the patient’s primary care provider (PCP), recommending initiation of a GLP-1 RA or SGLT2i. The primary outcome was the percentage of patients identified by the alert who were prescribed one of these medications. Secondary outcomes included documented reasons for not initiating GDMT and the provider type responsible for prescribing. Descriptive statistics were utilized.
RESULTS: The alert was triggered for 134 eligible patients. PCPs addressed the alert in the EHR for 61 cases (45.5%), and 26 patients (19.4%) were started on a GLP-1 RA or SGLT2i. The most frequent reasons for not initiating therapy were medication cost (n = 7), 11.5%) and contraindications (n = 5), 8.2%).
CONCLUSION: An interactive CDS prompted initiation of GDMT by primary care clinicians in nearly 20% of eligible T2D and ASCVD patients.
PMID:41866125 | DOI:10.1016/j.japh.2026.103081
