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

Wael E Eid; Emma Hatfield Sapp; Callen Conroy; Coby Bessinger; Cassidy L Moody; Ryan Yadav; Reece Tolliver; Joseph Nolan; Suzanne M Francis

doi:10.1016/j.ajpc.2024.100895

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

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

Authors

Wael E Eid^{1

2

3

4}, Emma Hatfield Sapp⁵, Callen Conroy⁶, Coby Bessinger⁶, Cassidy L Moody⁶, Ryan Yadav⁶, Reece Tolliver⁷, Joseph Nolan⁷, Suzanne M Francis⁵

Affiliations

¹ St. Elizabeth Physicians Regional Diabetes Center, Covington, Kentucky, USA.
² University of Kentucky College of Medicine, Lexington, Kentucky, USA.
³ University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA.
⁴ University of Alexandria Faculty of Medicine, Egypt.
⁵ St. Elizabeth Healthcare, 20 Medical Village Drive, Suite 103, Edgewood, KY 41017, USA.
⁶ University of Kentucky College of Medicine, 100 Grant Drive Highland Heights, KY, 41076, USA.
⁷ Northern Kentucky University Department of Mathematics and Statistics, Nunn Drive Highland Heights, KY, 41099, USA.

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.