Implementation strategies to improve statin utilization in individuals with hypercholesterolemia: a systematic review and meta-analysis

Abstract

Background Numerous implementation strategies to improve utilization of statins in patients with hypercholesterolemia have been utilized, with varying degrees of success. The aim of this systematic review is to determine the state of evidence of implementation strategies on the uptake of statins. Methods and results This systematic review identified and categorized implementation strategies, according to the Expert Recommendations for Implementing Change (ERIC) compilation, used in studies to improve statin use. We searched Ovid MEDLINE, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov from inception to October 2018. All included studies were reported in English and had at least one strategy to promote statin uptake that could be categorized using the ERIC compilation. Data extraction was completed independently, in duplicate, and disagreements were resolved by consensus. We extracted LDL-C (concentration and target achievement), statin prescribing, and statin adherence (percentage and target achievement). A total of 258 strategies were used across 86 trials. The median number of strategies used was 3 (SD 2.2, range 1–13). Implementation strategy descriptions often did not include key defining characteristics: temporality was reported in 59%, dose in 52%, affected outcome in 9%, and justification in 6%. Thirty-one trials reported at least 1 of the 3 outcomes of interest: significantly reduced LDL-C (standardized mean difference [SMD] − 0.17, 95% CI − 0.27 to − 0.07, p = 0.0006; odds ratio [OR] 1.33, 95% CI 1.13 to 1.58, p = 0.0008), increased rates of statin prescribing (OR 2.21, 95% CI 1.60 to 3.06, p < 0.0001), and improved statin adherence (SMD 0.13, 95% CI 0.06 to 0.19; p = 0.0002; OR 1.30, 95% CI 1.04 to 1.63, p = 0.023). The number of implementation strategies used per study positively influenced the efficacy outcomes. Conclusion Although studies demonstrated improved statin prescribing, statin adherence, and reduced LDL-C, no single strategy or group of strategies consistently improved outcomes. Trial registration PROSPERO CRD42018114952.

Successful implementation of best medical treatment for patients with asymptomatic carotid artery stenosis within a randomized controlled trial (SPACE-2)

“…Adequate medication compliance could be plausibly demonstrated with a significant reduction in cholesterol and LDL cholesterol levels in patients on statin medication relative to those without. These results are consistent with data from a meta-analysis of 86 randomized controlled trials, which also demonstrated significantly reduced LDL cholesterol, increased rates of statin prescription and improved statin adherence [13]. This study also showed improved LDL cholesterol reduction over time in studies published after 2012.…”

“…This study also showed improved LDL cholesterol reduction over time in studies published after 2012. However, this meta-analysis did not identify a single implementation strategy or group of implementation strategies with superior impact to others [ 13 ]. In the SPACE-2 trial, 42% of all patients smoking at baseline had quit smoking after one year.…”

“…Statins, in particular, have shown a significant impact on plaque stabilization and reduction in microembolisms with a consecutive reduced risk of vascular events [ 11 ]. Despite the clear evidence for the preventive benefits of statins, they are still underutilized [ 12 , 13 ]. A dose-dependent increase in mortality with nonadherence has been demonstrated [ 14 ].…”

Acceptability, Appropriateness, and Feasibility of Automated Screening Approaches and Family Communication Methods for Identification of Familial Hypercholesterolemia: Stakeholder Engagement Results from the IMPACT-FH Study

“…Some healthcare systems have implemented programs for FH identification, where computer reminders invite eligible patients, identified by FH clinical diagnostic criteria, into primary care practices [ 44 ]. While the feasibility of these interventions has been measured [ 44 ], a recent systematic review of implementation strategies specific to improving statin uptake has found that implementation strategies have not been well defined nor systematically utilized and tested in practice [ 45 ]. The current study demonstrates the potential for and use of methodologies from implementation science for improving the identification of a common, high-risk genetic condition.…”

Challenges of Statin Therapy in Clinical Practice (According to Outpatient Register «PROFILE» Data)

“…), она остается далекой от оптимальной [7][8][9]. Также исследователи отмечают затруднения в поиске и внедрении универсальной стратегии максимально эффективного применения статинов в клинической практике [10].…”