Opportunity 

Cardiovascular disease is the leading cause of morbidity and mortality in the United States. Statins are effective medications for reducing the risk of cardiovascular events. However, nearly 50 percent of patients who meet evidence-based guidelines for statins have never been prescribed one. 

Intervention 

We designed a cluster-randomized clinical trial to test active vs. passive choice framing in the electronic health record (EHR). We engaged 82 cardiologists from 16 practices providing care for more than 11,000 patients.   

In the passive choice arm, cardiologists had to manually access an alert embedded in the EHR and select options to initiate or increase statin therapy. In the active choice arm, a pop-up alert appeared, prompting a prescription for a specific dose of statins that cardiologists needed to accept or dismiss.  

Notifications in both arms flagged whether the patient had been diagnosed with atherosclerotic cardiovascular disease (ASCVD) or if they were at risk for it based on a clinical score. 

Impact 

Neither intervention resulted in a significant change in statin prescribing for the overall sample. However, the active choice intervention led to a significant increase in statin prescribing at the optimal dose among the subset of patients with ASCVD.