Less than 20% of children aged 2 to 11 years are screened for cholesterol, including those with cardiovascular risk factors, according to findings reported by Epic Research. We talked to the study investigators about simple strategies to increase lipid screening rates in children such as including reminders in standard charting and electronic health records.
“The health care system is missing opportunities for early identification and treatment of children at risk for heart disease,” said study coauthor Dave Little, MD, MS, who is a clinical informaticist at Epic.
Possible reasons for the low cholesterol screening rates include lack of provider awareness, lack of parental awareness, lack of reimbursement, fear of kids undergoing blood draws, and skepticism about the effectiveness of early intervention, according to Dr Little. “The correct answer is probably some combination of factors, and this would be a great opportunity for a survey.”
Cholesterol Screening Recommendations for Children
Lipid screening among children aged 9 to 11 years is recommended by an expert panel convened by the National Heart, Lung, and Blood Institute (NHLBI). Cholesterol screening for children aged 2 to 8 years is also recommended by the NHLBI panel and the American Academy of Pediatrics.
To determine lipid screening rates in the pediatric population, researchers reviewed cholesterol screening rates among 165,519 children aged 2 to 8 years with at least 1 cardiovascular risk factor that would qualify them for early screening and 237,548 patients aged 9 to 11 conducted between 2019 and 2022. The cardiovascular risk factors included dyslipidemia, obesity, type 2 diabetes, hypertension, family history of atherosclerotic cardiovascular disease, and secondhand smoke exposure.
These data were derived from Cosmos, a HIPAA-defined Limited Data Set of more than 185 million patients from 200 Epic organizations including 1147 hospitals and more than 25,000 clinics, serving patients in all 50 states and Lebanon. (Of the 208 organizations that contribute to Cosmos, one is located in Lebanon and data from Lebanon accounts for less than 0.5% of the clinics and hospitals represented in the study.)
Low Cholesterol Screening Rates Found Among Children
Cholesterol screening rates were 5.5% overall among children aged 2 to 8 years and 18.8% among those aged 9 to 11 years. Sensitivity analyses showed similar screening rates across sex and social vulnerability indices. Differences in screening rates by race and ethnicity were found with Hispanic patients being screened at higher rates than Black and White patients.
One-Third of Children Had High or Borderline-High Lipid Levels
Among patients who were screened for lipid levels, high lipid levels (≥200 mg/mL) were found among 13.5% of those aged 2 to 8 years with a cardiovascular risk factor and 9.3% of those aged 9 to 11 years. Additionally, approximately 25% of those screened in both age groups had borderline-high lipid levels (179-199 mg/mL).
How Can Primary Care Providers Improve Cholesterol Screening Rates?
Dr Little said that providers can improve rates of lipid screening using the following approaches:
- Include a reminder about lipid screening with other routine childhood resources (eg, vaccination records, growth chart, sports physical form)
- Include patient- and parent-directed messaging in office materials and handouts
- Consider a public service announcement or other public-facing tools to increase awareness
“The electronic health record can also be used to promote awareness and increase screening rates through a variety of methods,” Dr Little explained. These methods include the following:
- Include lipid screening in standard order sets and have this order selected by default.
- Include lipid screening in health maintenance trackers alongside immunization records and other care gap identification tools
- Consider interruptive decision support such as a pop-up alert to remind providers when a patient is due to be tested.
Little D, Deckert J, Barlet K, McNitt J. Few pediatric patients screened for high lipid levels despite expert recommendations. Epic Research; June 1, 2023. Accessed June 9, 2023. https://epicresearch.org/articles/few-pediatric-patients-screened-for-high-lipid-levels-despite-expert-recommendations