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Objectives: Limited research has assessed how virtual care (VC) affects cardiovascular disease (CVD) risk management, especially in community clinic settings. This study assessed change in community clinic patients' CVD risk management during the COVID-19 pandemic and CVD risk factor control among patients who had primarily in-person or primarily VC visits., Study Design: Retrospective interrupted time-series analysis., Methods: Data came from an electronic health record shared by 52 community clinics for index (March 1, 2019, to February 29, 2020) and follow-up (July 1, 2020, to February 28, 2022) periods. Analyses compared follow-up period changes in slope and level of population monthly means of 10-year reversible CVD risk score, blood pressure (BP), and hemoglobin A1c (HbA1c) among patients whose completed follow-up period visits were primarily in person vs primarily VC. Propensity score weighting minimized confounding., Results: There were 10,028 in-person and 6593 VC patients in CVD risk analyses, 9874 in-person and 5390 VC patients in BP analyses, and 8221 in-person and 4937 VC patients in HbA1c analyses. The VC group was more commonly younger, female, White, and urban. Mean reversible CVD risk, mean systolic BP, and percentage of BP measurements that were 140/90 mm Hg or higher increased significantly from index to follow-up periods in both groups. Rate of change between these periods was the same for all outcomes in both groups, regardless of care modality., Conclusions: Among community clinic patients with CVD risk, receiving a majority of care in person vs a majority of care via VC was not significantly associated with longitudinal trends in reversible CVD risk score or key CVD risk factors.

Objectives: Understanding how the COVID-19 pandemic affected cardiovascular disease (CVD) risk monitoring in primary care may inform new approaches for addressing modifiable CVD risks. This study examined how pandemic-driven changes in primary care delivery affected CVD risk management processes., Study Design: This retrospective study used electronic health record data from patients at 70 primary care community clinics with scheduled appointments from September 1, 2018, to September 30, 2021., Methods: Analyses examined associations between appointment type and select care process measures: appointment completion rates, time to appointment, and up-to-date documentation for blood pressure (BP) and hemoglobin A1c (HbA1c)., Results: Of 1,179,542 eligible scheduled primary care appointments, completion rates were higher for virtual care (VC) vs in-person appointments (10.7 percentage points [PP]; 95% CI, 10.5-11.0; P < .001). Time to appointment was shorter for VC vs in-person appointments (-3.9 days; 95% CI, -4.1 to -3.7; P < .001). BP documentation was higher for appointments completed pre- vs post pandemic onset (16.2 PP; 95% CI, 16.0-16.5; P < .001) and for appointments completed in person vs VC (54.9 PP; 95% CI, 54.6-55.2; P < .001). HbA1c documentation was higher for completed appointments after pandemic onset vs before (5.9 PP; 95% CI, 5.1-6.7; P < .001) and for completed VC appointments vs in-person appointments (3.9 PP; 95% CI, 3.0-4.7; P < .001)., Conclusions: After pandemic onset, appointment completion rates were higher, time to appointment was shorter, HbA1c documentation increased, and BP documentation decreased. Future research should explore the advantages of using VC for CVD risk management while continuing to monitor for unintended consequences.

Purpose: To assess the impact of a clinical decision support (CDS) system's recommendations on prescribing patterns targeting cardiovascular disease (CVD) when the recommendations are prioritized in order from greatest to least benefit toward overall CVD risk reduction., Methods: Secondary analysis of trial data from September 20, 2018, to March 15, 2020, where 70 community health center clinics were cluster-randomized to the CDS intervention (42 clinics; 8 organizations) or control group (28 clinics; 7 organizations). Included patients were medication-naïve and aged 40 to 75 years with ≥1 uncontrolled cardiovascular disease risk factor, with known diabetes or cardiovascular disease, or ≥10% 10-year reversible CVD risk., Results: Among eligible encounters with 29,771 patients, the probability of prescribing a medication targeting hypertension was greater at intervention clinic encounters when CDS was used (34.9% [95% CI, 31.5 to 38.3]) versus dismissed (29.6% [95% CI, 26.7 to 32.6]; P < .001 ), but not when compared with control clinic encounters (34.9% [95% CI, 31.1 to 38.7]; P = .998 ). Prescribing for dyslipidemia was significantly higher at intervention encounters where the CDS system was used (11.3% [95% CI, 9.3 to 13.3]) compared with dismissed (7.7% [95% CI, 6.1 to 9.3]; P = .003 ) and to control encounters (8.7% [95% CI, 7.0 to 10.4]; P = .044 ); smoking cessation medication showed a similar pattern. Except for dyslipidemia, prescribing rates increased according to their prioritization., Conclusions: Use of this CDS system was associated with significantly higher prescribing targeting most cardiovascular risk factors. These results highlight how displaying prioritized actions to reduce reversible CVD risk could improve risk management., Trial Registration: ClinicalTrials.gov, NCT03001713, https://clinicaltrials.gov/., Competing Interests: Conflict of interest: We have no conficts of interest to declare., (© Copyright by the American Board of Family Medicine.)

Importance: Management of cardiovascular disease (CVD) risk in socioeconomically vulnerable patients is suboptimal; better risk factor control could improve CVD outcomes., Objective: To evaluate the impact of a clinical decision support system (CDSS) targeting CVD risk in community health centers (CHCs)., Design, Setting, and Participants: This cluster randomized clinical trial included 70 CHC clinics randomized to an intervention group (42 clinics; 8 organizations) or a control group that received no intervention (28 clinics; 7 organizations) from September 20, 2018, to March 15, 2020. Randomization was by CHC organization accounting for organization size. Patients aged 40 to 75 years with (1) diabetes or atherosclerotic CVD and at least 1 uncontrolled major risk factor for CVD or (2) total reversible CVD risk of at least 10% were the population targeted by the CDSS intervention., Interventions: A point-of-care CDSS displaying real-time CVD risk factor control data and personalized, prioritized evidence-based care recommendations., Main Outcomes and Measures: One-year change in total CVD risk and reversible CVD risk (ie, the reduction in 10-year CVD risk that was considered achievable if 6 key risk factors reached evidence-based levels of control)., Results: Among the 18 578 eligible patients (9490 [51.1%] women; mean [SD] age, 58.7 [8.8] years), patients seen in control clinics (n = 7419) had higher mean (SD) baseline CVD risk (16.6% [12.8%]) than patients seen in intervention clinics (n = 11 159) (15.6% [12.3%]; P < .001); baseline reversible CVD risk was similarly higher among patients seen in control clinics. The CDSS was used at 19.8% of 91 988 eligible intervention clinic encounters. No population-level reduction in CVD risk was seen in patients in control or intervention clinics; mean reversible risk improved significantly more among patients in control (-0.1% [95% CI, -0.3% to -0.02%]) than intervention clinics (0.4% [95% CI, 0.3% to 0.5%]; P < .001). However, when the CDSS was used, both risk measures decreased more among patients with high baseline risk in intervention than control clinics; notably, mean reversible risk decreased by an absolute 4.4% (95% CI, -5.2% to -3.7%) among patients in intervention clinics compared with 2.7% (95% CI, -3.4% to -1.9%) among patients in control clinics (P = .001)., Conclusions and Relevance: The CDSS had low use rates and failed to improve CVD risk in the overall population but appeared to have a benefit on CVD risk when it was consistently used for patients with high baseline risk treated in CHCs. Despite some limitations, these results provide preliminary evidence that this technology has the potential to improve clinical care in socioeconomically vulnerable patients with high CVD risk., Trial Registration: ClinicalTrials.gov Identifier: NCT03001713.

Context: Racial and ethnic minorities in the United States have higher mortality/morbidity from cardiovascular disease (CVD) compared to non-Hispanic whites, and some evidence has suggested that poor risk factor control, including appropriate prescribing of statins for lipid disorders and CVD risk reduction, contributes to these disparities. It is uncertain if the 2013 American Heart Association (AHA)/American College of Cardiology (ACC) guideline change for statin prescription affected this disparity. Objective: To compare the prevalence of patients with guideline indications for statin prescribing, and to compare prescribing prevalence before and after this major guideline change between racial and ethnic groups, by preferred language. Study Design: Retrospective, cohort study. Setting/Dataset: A national network of community health centers (CHCs) linked by a common electronic health record dataset. Population studied: Patients were age 50-73, and had =1 primary care visit in 2009-2013 and/or 2014-2018. Outcomes: By period, 1) proportion with period-specific indications for statin initiation 2) proportion with a statin prescription if indicated. Results: In the 2009-2013 period (N=109,330), non-English preferring White (OR=1.41, 95% CI 1.15-1.72), Black (OR=1.25, 95% CI 1.10-1.41), and Latino patients (OR=1.09, 95% CI 1.02-1.16) had higher odds of meeting guideline indications for statins than Non-Hispanic White English preferring patients, and of those meeting indications, all except Black non-English patients had higher odds of statin prescription. In the 2014-2018 period (N=319,094), all groups except Latino English-preferred and White Non-English preferred patients had higher odds of meeting the new guideline indications for statin prescription. Of those meeting indications in this period, Latino English speakers had similar odds of statin prescription as non-Hispanic whites; English preferring Black patients had lower odds (OR=0.95, 95% CI 0.91-0.99). Conclusions: CHCs provide CVD screening and statin prescriptions for thousands of racial, ethnic, and language minorities, even more so than some non-Hispanic white English speakers. However, disparities appeared for English preferring Latino and Black patients after the 2013 ACC/AHA guideline change. The evaluation of major clinical guideline changes should account for their impact on racial and ethnic disparities. [ABSTRACT FROM AUTHOR]