Background: Cardiovascular risk management (CVRM) is notoriously difficult because of multi-morbidity and the
different phenotypes and severities of cardiovascular disease. Computerized decision support systems (CDSS) enable
the clinician to integrate the latest scientific evidence and patient information into tailored strategies. The effect on
cardiovascular risk factor management is yet to be confirmed.
Methods: We performed a systematic review and meta-analysis evaluating the effects of CDSS on CVRM, defined as
the change in absolute values and attainment of treatment goals of systolic blood pressure (SBP), low density
lipoprotein cholesterol (LDL-c) and HbA1c. Also, CDSS characteristics related to more effective CVRM were identified.
Eligible articles were methodologically appraised using the Cochrane risk of bias tool. We calculated mean differences,
relative risks, and if appropriate (I2 < 70%), pooled the results using a random-effects model.
Results: Of the 14,335 studies identified, 22 were included. Four studies reported on SBP, 3 on LDL-c, 10 on CVRM in
patients with type II diabetes and 5 on guideline adherence. The CDSSs varied considerably in technical performance
and content. Heterogeneity of results was such that quantitative pooling was often not appropriate. Among CVRM
patients, the results tended towards a beneficial effect of CDSS, but only LDL-c target attainment in diabetes patients
reached statistical significance. Prompting, integration into the electronical health record, patient empowerment, and
medication support were related to more effective CVRM.
Conclusion: We did not find a clear clinical benefit from CDSS in cardiovascular risk factor levels and target attainment.
Some features of CDSS seem more promising than others. However, the variability in CDSS characteristics and
heterogeneity of the results – emphasizing the immaturity of this research area - limit stronger conclusions.
Clinical relevance of CDSS in CVRM might additionally be sought in the improvement of shared decision making and
patient empowerment