Intended for healthcare professionals

Clinical Review State of the Art Review

Clinical decision support in cardiovascular medicine

BMJ 2022; 377 doi: (Published 25 May 2022) Cite this as: BMJ 2022;377:e059818
  1. Yuan Lu, assistant professor1 2,
  2. Edward R Melnick, associate professor3 4,
  3. Harlan M Krumholz, professor1 2 5
  1. 1Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA
  2. 2Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
  3. 3Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
  4. 4Department of Biostatistics (Health Informatics), Yale School of Public Health, New Haven, CT, USA
  5. 5Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
  1. Correspondence to: H M Krumholz harlan.krumholz{at}


Despite considerable progress in tackling cardiovascular disease over the past 50 years, many gaps in the quality of care for cardiovascular disease remain. Multiple missed opportunities have been identified at every step in the prevention and treatment of cardiovascular disease, such as failure to make risk factor modifications, failure to diagnose cardiovascular disease, and failure to use proper evidence based treatments. With the digital transformation of medicine and advances in health information technology, clinical decision support (CDS) tools offer promise to enhance the efficiency and effectiveness of delivery of cardiovascular care. However, to date, the promise of CDS delivering scalable and sustained value for patient care in clinical practice has not been realized. This article reviews the evidence on key emerging questions around the development, implementation, and regulation of CDS with a focus on cardiovascular disease. It first reviews evidence on the effectiveness of CDS on healthcare process and clinical outcomes related to cardiovascular disease and design features associated with CDS effectiveness. It then reviews the barriers encountered during implementation of CDS in cardiovascular care, with a focus on unintended consequences and strategies to promote successful implementation. Finally, it reviews the legal and regulatory environment of CDS with specific examples for cardiovascular disease.


  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Contributors: YL, ERM, and HMK conceived and designed this review. YL did the search and selected the studies for inclusion. YL drafted the manuscript, and ERM and HMK edited and approved the final version.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: HMK has received personal fees from UnitedHealth, Element Science, Aetna, Reality Labs, F-Prime, Siegfried & Jensen Law Firm, Martin/Baughman Law Firm, and Arnold and Porter Law Firm and grants from Johnson & Johnson; he is a co-founder of HugoHealth, a personal health information platform, and co-founder of Refactor Health, an enterprise healthcare artificial intelligence-augmented data management company, and he has contracts from Centers for Medicare & Medicaid Services Contracts, through Yale New Haven Hospital, to develop and maintain performance measures that are publicly reported outside the submitted work; YL is supported in part by the National Heart, Lung, and Blood Institute (K12HL138037) and the Yale Center for Implementation Science; ERM is supported in part by the National Institute On Drug Abuse of the National Institutes of Health under Award Number UH3DA047003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Patient involvement: No patients were asked for input in the creation of this article.

  • Provenance and peer review: Commissioned; externally peer reviewed.

View Full Text

Log in

Log in through your institution


* For online subscription