Active vs. passive choice framing to increase statin prescribing among cardiologists


Cardiovascular disease is the leading cause of morbidity and mortality in the United States. Statins are effective medications for reducing the risk of cardiovascular events. However, many patients who meet evidence-based guidelines are not receiving appropriate statin therapy.


We designed a randomized clinical trial to test active vs. passive choice framing in the electronic health record (EHR) to cardiologists. Active choice framing uses alerts in the EHR that block clinician workflow until a decision is made. Passive choice framing enables a cardiologist to open a decision-making choice set to check if a patient’s therapy needs to be adjusted.


In this cluster-randomized clinical trial of 82 cardiologists from 16 practices, including 11,693 patients, neither intervention resulted in a significant change in statin prescribing for the overall sample. Among the subset of patients with an atherosclerotic cardiovascular disease clinical diagnosis, the active choice intervention led to a significant increase in statin prescribing at the optimal dose, but the passive choice intervention did not.