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Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. 2010 April 1; 60(573): e137–e143.
PMCID: PMC2845504

Automated electronic reminders to facilitate primary cardiovascular disease prevention: randomised controlled trial

Tim A Holt, MRCP, FRCGP, Clinical Lecturer, Margaret Thorogood, PhD, FFPH, Professor of Epidemiology, and Frances Griffiths, PhD, FRCGP, Associate Clinical Professor (Reader)
Health Sciences Research Institute, University of Warwick, Coventry
Stephen Munday, MRCGP, FFPHM, Director of Public Health
Solihull NHS Care Trust, Solihull
Tim Friede, PhD, Associate Professor of Medical Statistics
Health Sciences Research Institute, University of Warwick, Coventry
David Stables, MBChB, Medical Director



Primary care databases contain cardiovascular disease risk factor data, but practical tools are required to improve identification of at-risk patients.


To test the effects of a system of electronic reminders (the ‘e-Nudge’) on cardiovascular events and the adequacy of data for cardiovascular risk estimation.

Design of study

Randomised controlled trial.


Nineteen general practices in the West Midlands, UK.


The e-Nudge identifies four groups of patients aged over 50 years on the basis of estimated cardiovascular risk and adequacy of risk factor data in general practice computers. Screen messages highlight individuals at raised risk and prompt users to complete risk profiles where necessary. The proportion of the study population in the four groups was measured, as well as the rate of cardiovascular events in each arm after 2 years.


Over 38 000 patients' electronic records were randomised. The intervention led to an increase in the proportion of patients with sufficient data who were identifiably at risk, with a difference of 1.94% compared to the control group (95% confidence interval [CI] = 1.38 to 2.50, P<0.001). A corresponding reduction occurred in the proportion potentially at risk but requiring further data for a risk estimation (difference = –3.68%, 95% CI = –4.53 to –2.84, P<0.001). No significant difference was observed in the incidence of cardiovascular events (rate ratio = 0.96, 95% CI = 0.85 to 1.10, P = 0.59).


Automated electronic reminders using routinely collected primary care data can improve the adequacy of cardiovascular risk factor information during everyday practice and increase the visibility of the at-risk population.

Keywords: cardiovascular diseases, primary prevention, reminder systems, risk assessment, informatics

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners