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 cluster-randomized clinical trial to test active vs. passive choice framing in the electronic health record (EHR) to cardiologists. We engaged 82 cardiologists from 16 practices providing care for more than 11,000 patients. The active choice framing used alerts to block clinician workflow until a decision was made. The passive choice framing enabled cardiologists to open a decision-making choice set to check if a patient’s therapy needed to be adjusted.


Neither intervention resulted in a significant change in statin prescribing for the overall sample. However, the active choice intervention led to a significant increase in statin prescribing at the optimal dose among the subset of patients with an atherosclerotic cardiovascular disease diagnosis.