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Original article

Randomized trial of a computerized coronary heart disease risk assessment tool in HIV-infected patients receiving combination antiretroviral therapy

Heiner C Bucher, Martin Rickenbach, Jim Young, Tracy R Glass, Yannick Vallet, Enos Bernasconi, Matthias Cavassini, Christoph Fux, Véronique Schiffer, Pietro Vernazza, Rainer Weber, Manuel Battegay, the Swiss HIV Cohort Study

Corresponding author name: Heiner C Bucher
Corresponding author e-mail: hbucher@uhbs.ch

Citation: Antiviral Therapy 2010; 15:31-40
doi: 10.3851/IMP1475

Date accepted: 21 July 2009
Date published online: 06 January 2010

Abstract

Background: Exposure to combination antiretroviral therapy (cART) can lead to important metabolic changes and increased risk of coronary heart disease (CHD). Computerized clinical decision support systems have been advocated to improve the management of patients at risk for CHD but it is unclear whether such systems reduce patients’ risk for CHD.

Methods: We conducted a cluster trial within the Swiss HIV Cohort Study (SHCS) of HIV-infected patients, aged 18 years or older, not pregnant and receiving cART for >3 months. We randomized 165 physicians to either guidelines for CHD risk factor management alone or guidelines plus CHD risk profiles. Risk profiles included the Framingham risk score, CHD drug prescriptions and CHD events based on biannual assessments, and were continuously updated by the SHCS data centre and integrated into patient charts by study nurses. Outcome measures were total cholesterol, systolic and diastolic blood pressure and Framingham risk score.

Results: A total of 3,266 patients (80% of those eligible) had a final assessment of the primary outcome at least 12 months after the start of the trial. Mean (95% confidence interval) patient differences where physicians received CHD risk profiles and guidelines, rather than guidelines alone, were total cholesterol -0.02 mmol/l (-0.09–0.06), systolic blood pressure -0.4 mmHg (-1.6–0.8), diastolic blood pressure -0.4 mmHg (-1.5–0.7) and Framingham 10-year risk score -0.2% (-0.5–0.1).

Conclusions: Systemic computerized routine provision of CHD risk profiles in addition to guidelines does not significantly improve risk factors for CHD in patients on cART.

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