Physicians' Academy for Cardiovascular Education

Online self-assessment to test eligibility for nonprescription statin therapy

Technology-Assisted Self-Selection of Candidates for Nonprescription Statin Therapy

Literature - Nissen SE, Hutchinson HG, Wang TY et al. - J Am Coll Cardiol. 2021 Sep 14;78(11):1114-1123. doi: 10.1016/j.jacc.2021.06.048.

Introduction and methods


A large proportion of patients eligible for statin therapy remain untreated [1,2]. Prior efforts to achieve regulatory approval of nonprescription statins were unsuccessful as they were unable to demonstrate that only eligible consumers would receive appropriate treatment [3-7].

Aim of the study

This study compared the concordance between participant and clinician assessment of eligibility for rosuvastatin 5 mg using an at-home web-based application.

Online self-assessment

Participants used the web-based application to respond to questions related to medical history, medication use, total cholesterol (TC), HDL-c, LDL-c, triglycerides (TG), blood pressure, and if needed, waist circumference, hsCRP and coronary artery calcium (CAC) score. Eligibility for treatment with rosuvastatin 5 mg was assessed by the web application using the ACC/AHA 2018 Cholesterol Treatment Guidelines and a proposed drug facts label for nonprescription rosuvastatin [8]. The application released 1 of 3 possible self-selection outcomes: “OK to use”, “not right for you” or “ask a doctor”.

Clinician assessment

After completion of the online self-assessment, participants visited a research site and were instructed to bring verification documents of the laboratory values and BP (not older than 12 months). This information was provided to a telemedicine clinician who conducted an independent medical evaluation using the same web application used by the participant.A total of 500 participants completed the study of whom 83 had limited literacy.


The primary outcome was the proportion of participants whose technology-assisted self-assessment outcome was identical to the clinician’s technology-assisted assessment.

The secondary outcome was the percentage of participants with correct entries for all self-selection questions.

Main results

primary outcome

Details of discordant cases

Secondary outcome


Self-assessment using an web application to test eligibility for statin therapy achieved high concordance with the clinician’s assessment: The self-assessment outcome was identical to the clinician’s technology-assisted assessment in >95% of cases.


Show references

Find this article online at J Am Coll Cardiol.

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