@article{Stevens:2025,
author = {Stevens, C and Smith, J and Brandts, J and Barkas, F and Moreno, Morales M and Janani, L and Kiru, G and Kaza, N and Cornelius, V and Poulter, N and Khunti, K and McEvoy, JW and Zambon, A and Lopez-sendon, JL and Connolly, D and Hazell, L and Ray, K},
journal = {European Heart Journal: Digital Health},
title = {Optimising lipid-lowering therapy for acute coronary syndrome using a decision support system: insights from a cluster randomised trial},
year = {2025}
}

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TY  - JOUR
AB  - AIMS: Lipid-lowering therapy (LLT) after acute coronary syndrome (ACS) typically follows stepwise intensification, delaying use of combination therapies and LDL-C goal attainment. We assessed whether access to a Decision Support System (DSS) altered the intensity of LLT prescribing vs standard-of-care (SoC).METHODS: Pragmatic, multinational, parallel 1:1 cluster-randomised controlled trial of ACS patients comparingmandatory access to a DSS (providing estimates of cardiovascular events and benefits from different LLT scenarios) to SoC. The primary endpoint was the proportion receiving intensified monotherapy or initiated/escalated combination LLT by week 16 compared to pre-admission LLT; secondary endpoints included individual components of the primary endpoint, proportions at goal (LDL-C<1.4mmol/L), and timing of LLT escalations.RESULTS: 42 sites from UK, Italy and Spain were randomised, enrolling 1139 participants, 79% male, median age 62 years (IQR: 55, 69), 84% without prior CVD, 69% LLT-naïve at admission, median admission LDL-C 3.0 mmol/L (IQR: 2.46, 3.75). The primary endpoint was met in 71.7% (DSS) vs 65.7% (SoC), risk ratio (RR) 1.11 (95%CI:0.92-1.33, p=0.29). Intensification of monotherapy occurred in 9.0% vs 13.1% (RR:0.68, 95%CI:0.46-1.00), combination LLT in 61.6% vs 50.6% (RR:1.35, 95%CI:0.93-1.98). LDL-C goal achievement was 54.8% vs 50.3% (RR 1.06, 95%CI: 0.88-1.28), with LLT escalation before discharge in 64.8% vs 60.7%.CONCLUSIONS: Access to a DSS, in hospitals managing ACS, did not improve LLT intensification within 16 weeks or LDL-C goal attainment, but revealed a favourable trend towards earlier combination LLT use, which merits larger, longer studies in other settings.
AU  - Stevens,C
AU  - Smith,J
AU  - Brandts,J
AU  - Barkas,F
AU  - Moreno,Morales M
AU  - Janani,L
AU  - Kiru,G
AU  - Kaza,N
AU  - Cornelius,V
AU  - Poulter,N
AU  - Khunti,K
AU  - McEvoy,JW
AU  - Zambon,A
AU  - Lopez-sendon,JL
AU  - Connolly,D
AU  - Hazell,L
AU  - Ray,K
PY  - 2025///
SN  - 2634-3916
TI  - Optimising lipid-lowering therapy for acute coronary syndrome using a decision support system: insights from a cluster randomised trial
T2  - European Heart Journal: Digital Health
ER  - 

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