Do electronic "nudges" or decision-support systems impact patient and clinician decision-making? Two separate studies presented at AHA 2024 explore answers to this question, specifically in the areas of flu vaccination rates and optimization of lipid-lowering therapies.

In a pooled analysis of NUDGE-FLU, NUDGE-FLU-2, and NUDGE-FLU CHRONIC during the 2022-2023 and 2023-2024 flu seasons, researchers found that electronic messaging emphasizing the potential cardiovascular benefits of flu vaccines improved vaccination rates in Denmark, especially among patients with a history of acute myocardial infarction (AMI).

Results from the analysis showed trial participants who received any of the nudge email letters had higher rates of vaccination, including an improvement of 1.8% among AMI survivors and an increase of 1.3% among adults without a history of heart attack.

A message that outlined the potential cardiovascular benefits of flu shots was more effective, leading to a 3.9% increase in vaccination among people with a history of heart attack compared to a 2% increase for those with no heart attack history.

Researchers noted that among AMI survivors, an email focused on cardiovascular benefits was even more successful among those who were not vaccinated in the previous flu season. People in this subcategory had a flu vaccine improvement rate of nearly 14% compared to an improvement in heart attack survivors who were previously vaccinated of only about 1.5%.

"The data suggest that cardiovascular focused messaging was effective across a broad population; this strategy should be considered as part of a suite of strategies to improve cardiovascular prevention and encourage flu vaccination among high-risk patients, including those with a history of heart attack," said lead author Ankeet Bhatt, MD, MBA, ScM.

The study had several limitations, including that it was based on a prespecified, secondary analysis across the three trials. In addition, flu vaccination rates in Denmark were high, especially among older adults, and may not be representative of rates in other parts of the world. Whether that changes the effectiveness of this strategy in populations with lower vaccination rates requires further study, and validation efforts are already under way in the U.S., Bhatt said.

As part of the ZODIAC study, researchers explored the optimization of lipid lowering therapies using a decision-support system in patients with acute coronary syndrome (ACS). "Getting to lipid goals early and sustaining the progress provides the best cardiovascular outcomes," said Kausik K. Ray, MD, FACC, in presenting the findings.

The study of 1,139 patients (<80 years) in the UK, Italy and Spain, compared standard of care with a decision-support system to assess whether access to a decision-support system increases early initiation or intensification of lipid-lowering therapies with 16 weeks post-ACS. While small shifts were observed in prescribing behavior toward more potent combination and more participants received their first lipid-lowering therapy escalation before discharge among those assigned to use a decision-support system, the availability of a decision-support system did not significantly lead to improvement compared with current care pathways. Additionally, the availability of a decision-support system did not result in statistically significant achievements in LDL-C goals within the 16-weeks of ACS.

According to Ray, the lack of a significant difference between the two groups may be the result of improvements in the usual care pathway, including increased early use of combination therapies. Additionally, he adds that the favorable trends observed in the [decision-support system] arm "may have value in other settings where the implementation is slower, such as primary care, but that will require further study."