Interventions to Reduce Clinical Inertia in Cardiac Risk Factor Management in Renal Transplant Recipients

Cardiovascular disease (CVD) is the leading cause of death in renal transplant recipients (RTRs). Clinical inertia (CI) is defined as "recognition of the problem, but failure to act." The effect of educational interventions in minimizing CI in CVD risk factor management was assessed. Educational sessions were conducted among 201 RTRs to inform them about their goals for blood pressure (BP), low-density lipoprotein cholesterol (LDL-C) and glycated hemoglobin (HbA_1c). Physicians were reminded about treatment goals using checklists. Pre-intervention and post-intervention CI was measured as "no action" or "appropriate action" by the physicians. Post-intervention percentage of RTRs with "no clinical action" for BP, LDL-C, and HbA_1c control decreased from 10.8% to 3.8% (P= 02), 28.2% to 11.1% (P=008), and 10.3% to 4.5% (P=05), respectively, while those with "appropriate action" increased from 66.2% to 83.3% (P<.001), 68.7% to 79.4% (P=008), and 85.1% to 93.2% (P=03), respectively. Educational interventions and patient participation were shown to reduce CI.