Guideline Concordance of Statin Treatment Decisions: A Retrospective Cohort Study

Abstract

Guidelines recommend initiation of statins depending on cardiovascular risk and low-density lipoprotein cholesterol (LDL-C) levels. In this retrospective cohort study, we aimed to assess guideline concordance of statin treatment decisions and to find determinants of undertreatment in Swiss primary care in the period 2016–2019. We drew on electronic medical records of 8060 statin-naive patients (50.0% female, median age 59 years) with available LDL-C levels and cardiovascular risk. Guideline concordance was assessed based on the recommendations of the European Society of Cardiology, and multilevel logistic regression was performed to find determinants of undertreatment. We found that statin treatment was initiated in 10.2% of patients during one year of follow up. Treatment decisions were classified as guideline-concordant in 63.0%, as undertreatment in 35.8% and as overtreatment in 1.2%. Among determinants of undertreatment were small deviation from LDL-C treatment thresholds (odds ratio per decrease by 1 mmol/L: 2.09 [95% confidence interval 1.87–2.35]), high compared with very high cardiovascular risk (1.64 [1.30–2.05]), female sex (1.31 [1.05–1.64]), and being treated by older general practitioners (per 10 year decrease: 0.74 [0.61–0.90]). In conclusion, undertreatment of patients at high or very high cardiovascular risk was common, but general practitioners considered cardiovascular risk and LDL-C in their treatment decisions.

Prescription Rates, Polypharmacy and Prescriber Variability in Swiss General Practice—A Cross-Sectional Database Study

“…Contrary, a higher prescription rate among male patients was observed for cardiovascular medications. While this finding is highly consistent with reports from other studies ( Schnegg et al, 2020 ; Zhao et al, 2020 ), the higher intrinsic cardiovascular risk of male patients may not be the only explanation, as female patients have been found to receive less intensive cardiovascular care than men even when at similar risk ( Rachamin et al, 2020a , 2020b , 2021 ).…”

Evaluation of type 2 diabetes care management in nine primary care practices before and after implementation of the Criteria of Good Disease Management of Diabetes established by the Swiss Society of Endocrinology and Diabetology

“…In addition, screening for diabetes-related complications was low and not consistently performed in all patients with diabetes. The finding of insufficient evaluation and control of cardiovascular risk factors in patients with diabetes is consistent with previous findings [18,17]. Similarly, the lack of consistent assessment of diabetic-related complications has been previously observed in Switzerland [19].…”

“…The documented modalities of therapy in the current study are consistent with previous reports with around ~80% of patients receiving oral antidiabetic drugs, ~20% additionally insulin, ~80% antihypertensive therapy and only ~50% statins [9,17,18]. In 2018 only minor changes were documented with regard to antidiabetic therapy (a decreased percentage of patients with oral antidiabetic drugs and an increased proportion on insulin therapy).…”

Quality and variation of care for chronic kidney disease in Swiss general practice: A retrospective database study

“…While new evidence supporting intensive blood pressure control also in the elderly has been integrated into the 2021 update of the KDIGO guidelines [ 44 , 45 ], the observed behaviour was in accordance with recommendations pertinent to the study period [ 46 ]. On the other hand, the comparatively low prescription rates of cholesterol-lowering drugs in CKD patients aged 50–80 years were more concerning, and may reflect a generally prevalent undertreatment with statins found in Swiss general practice [ 47 ].…”