Cardiology clinic visit increases likelihood of evidence‐based cholesterol prescribing in severe hypercholesterolemia

Abstract

Background Patients with phenotypic severe hypercholesterolemia (SH), low‐density lipoprotein‐cholesterol (LDL‐c) ≥ 190 mg/dl, atherosclerotic cardiovascular disease (ASCVD) or adults 40–75 years with diabetes with risk factors or 10‐year ASCVD risk ≥20% benefit from maximally tolerated statin therapy. Rural patients have decreased access to specialty care, potentially limiting appropriate treatment. Hypothesis Prior visit with cardiology will improve treatment of severe hypercholesterolemia. Methods We used an electronic medical record‐based SH registry defined as ever having an LDL‐c ≥ 190 mg/dl since January 1, 2000 (n = 18 072). We excluded 3205 (17.7%) patients not alive or age 20–75 years. Patients defined as not seen by cardiology if they had no visit within the past 3 years (2017–2019). Results We included 14 867 patients (82.3%; mean age 59.7 ± 10.3 years; 58.7% female). Most patients were not seen by cardiology (n = 13 072; 72.3%). After adjusting for age, sex, CVD, hypertension, diabetes and obesity, patients seen by cardiology were more likely to have any lipid‐lowering medication (OR = 1.46, 95% CI: 1.29–1.65), high‐intensity statin (OR = 1.81, 95% CI: 1.61–2.03), or proprotein convertase subtilisin‐kexin type 9 (PCSK9) inhibitor (OR = 5.96, 95% CI: 3.34–10.65) compared to those not seen by cardiology. Mean recent LDL‐c was lower in patients seen by cardiology (126.8 ± 51.6 mg/dl vs. 152.4 ± 50.2 mg/dl, respectively; p < .001). Conclusion In our predominantly rural population, a visit with cardiology improved the likelihood to be prescribed any statin, a high‐intensity statin, or PCSK9 inhibitor. This more appropriately addressed their high life‐time risk of ASCVD. Access to specialty care could improve SH patient's outcomes.

Closing the Gaps in Care of Dyslipidemia: Revolutionizing Management with Digital Health and Innovative Care Models

“…In this vein, many argue that there are clear unintended consequences of the need for prior authorizations for PCSK9-I, including heavy administrative burden and indiscriminately high rejection rates, and advocate for a redesign of the prior authorization process [ 88 ]. In addition to medication access, access to care—the ability to participate in regular follow-up—has also been demonstrated to correlate with both statin prescriptions and adherence [ 89 , 90 ]. Irrespective of access to medications and care, however, disparities in statin prescription and use based on patient factors such as race/ethnicity, sex, age, socioeconomic status, and comorbidities have been consistently reported [ 91 , 92 ].…”

Nonadherence to lipid‐lowering therapy and strategies to improve adherence in patients with atherosclerotic cardiovascular disease

“…Access to healthcare and associated treatment support is another established factor impacting LLT adherence. 20,30 One example of this association comes from a Veterans Affairs healthcare system study of patients with ASCVD on statin therapy who had at least one primary care visit between October 2013 and September 2014 that linked lipid monitoring frequency with adherence to statins, suggesting that lipid monitoring may improve statin adherence. 20 The type of clinical practice visited may also impact compliance with statin guideline recommendations and treatment benefit.…”