Longitudinal automated lipid target monitoring integrated into a laboratory-based clinical decision support system: a real-world cardiovascular risk management approach.

OBJECTIVES

To evaluate a laboratory-integrated CDSS for lipid monitoring after cardiovascular risk classification.

METHODS

An opportunistic laboratory-based CDSS was implemented at Hospital La Fe (València), for primary care lipid requests. Cardiovascular risk was assigned hierarchically by combining direct ESC/EAS guideline-based clinical staging with structured reuse of Lp(a)-adjusted SCORE2-, SCORE2-OP-, or SCORE2-Diabetes-based risk estimations generated by a separate CDSS. The highest risk category prevailed, and new relevant conditions triggered automatic reassessment. LDL-C target attainment was evaluated when TG were < 400 mg/dL, whereas non-HDL-C was used for TG ≥ 400 mg/dL. Above-target results generated an interpretive report for clinicians. Lipid control, lipid lowering treatment (LLT) exposure, direct staging conditions, age patterns, and longitudinal treatment trajectories were analyzed.

RESULTS

During the first 4 months, the CDSS evaluated 9507 eligible requests: 7353 (77.1%) were very high risk, 1881 (20.1%) high risk, 210 (2.2%) moderate risk, and 63 (0.7%) low risk. Lipid target attainment was 14.9%, 7.8%, 25.2%, and 57.1%, respectively. Poor lipid control remained high across age strata, particularly in moderate- to very-high-risk patients. Poor control persisted despite 79.4% recorded LLT exposure in off-target very-high-risk patients. Non-HDL-C assessment was required in 93 patients with TG ≥400 mg/dL, none of whom achieved lipid targets. In the subgroup of 330 patients previously stratified by the separate SCORE2-based CDSS, without direct staging criteria or baseline LLT, 85.2% had baseline poor lipid control; 39.1% initiated LLT during follow-up, and 23.1% subsequently achieved lipid targets.

CONCLUSIONS

This CDSS enabled automated risk reassessment and longitudinal lipid target monitoring in primary care.