Relation Between Cardiology Follow-Up Visits, Evidence-Based Statin Prescribing, and Statin Adherence (from the Veterans Affairs Health Care System)

Rehman, Hasan; Ahmed, Sarah T.; Akeroyd, Julia M.; Mahtta, Dhruv; Jia, Xiaoming; Rifai, Mahmoud Al; Nasir, Khurram; Jneid, Hani; Khalid, Mirza Umair; Alam, Mahboob; Tóth, Peter P.; Virani, Salim S.

doi:10.1016/j.amjcard.2019.07.022

Cited by 7 publications

(8 citation statements)

References 26 publications

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“…We found that even after adjusting for baseline differences, patients who had been seen by cardiology had 46% higher odds of being prescribed any lipid‐lowering medication and 81% higher odds of being prescribed a high‐intensity statin, as well as six times higher odds of a prescription for PCSK9 inhibitor. These results are consistent with those previously observed in the Veterans Affairs Health Care System that showed a higher percentage of patients with ASCVD who saw cardiology had been prescribed high‐intensity statins 9 …”

Section: Discussionsupporting

confidence: 92%

“…Despite the overwhelming evidence for lipid‐lowering medication use, less than half of our patients with phenotypic SH were prescribed lipid‐lowering medication at a large healthcare system. Similar results have been seen in previous studies examining the use of lipid‐lowering medications 8,9,21,22 . Bradley C.K.…”

Section: Discussionsupporting

confidence: 88%

“…Prior studies of patients with ASCVD in the Veterans Affairs system found similar results, showing a dose response relationship with patients having a higher statin use and statin adherence if they had more visits by either cardiology or primary care 9,18 . Other studies have noted routine, guideline‐directed completion of lipid panels is associated with a modest increase in statin adherence 15 .…”

Section: Discussionmentioning

confidence: 72%

“…One of the top 10 take‐home messages for primary prevention of CVD in the 2018 guideline on cholesterol management recommends patients with primary SH be started on a maximally tolerated statin therapy without further risk stratification 7 . Despite the overwhelming evidence for statin therapy, there is still a large divide in patients who are eligible for and recommended by the national guidelines to be on a statin and those who are actually receiving statin therapy 8‐11 …”

Section: Introductionmentioning

confidence: 99%

“…The impact of being seen by cardiology on the use of lipid‐lowering medication is not well‐characterized 9 . We aimed to evaluate use of statins in SH patients in our predominantly rural population, based on prior visit with cardiology.…”

Section: Introductionmentioning

confidence: 99%

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

Groth

Stone

Benziger

2020

Clinical Cardiology

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Groth

Stone

Benziger

2020

Clinical Cardiology

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Statin Use in Older Adults for Primary Cardiovascular Disease Prevention Across a Spectrum of Cardiovascular Risk

et al. 2021

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BACKGROUND: There remains uncertainty regarding optimal primary atherosclerotic cardiovascular disease (ASCVD) prevention practices for older adults. OBJECTIVE: To assess statin treatment patterns and incident ASCVD among older patients for primary prevention across the spectrum of ASCVD risk. DESIGN: Retrospective cohort study of participants without ASCVD aged 65-79 years. Patients were stratified by age (65-69, 70-75, > 75 years) and 10-year ASCVD risk category (low/borderline, intermediate, high) based on the Pooled Cohort Equations. Multivariable logistic regressions were used to identify predictors of moderate-or high-intensity statin prescriptions. Cox proportional models were used to estimate hazard ratios (HRs) for incident ASCVD. PARTICIPANTS: Patients aged 65-79 years without ASCVD from a Northern California health system. MAIN MEASURES: Statin prescriptions and incident ASCVD events. KEY RESULTS: There were 54,066 patients, with 10,288 (19%) aged > 75 years and 57% women. Compared with younger groups, adults > 75 years were less likely to be prescribed moderate-or high-intensity statin prescriptions across ASCVD risk groups (all p < 0.001); this persisted after multivariable adjustment including for ASCVD risk (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.74-0.86). Adults > 75 years were more likely to experience incident ASCVD (HR 1.42, 95% CI 1.23-1.63). Women (OR 0.85, 95% CI 0.81-0.89) and underweight older adults (OR 0.45, 95% CI 0.33-0.61) were also less likely to receive moderate-or high-intensity statins. CONCLUSIONS: Among older adults aged 65-79 years without prior ASCVD, those > 75 years of age were less likely to receive moderate-or high-intensity statins regardless of ASCVD risk compared with their younger counterparts, while experiencing more incident ASCVD. Efforts are warranted to study the reasons for age-based differences in statin use in older adults, particularly those at highest ASCVD risk.

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Persistence and Adherence to PCSK9 Inhibitor Monoclonal Antibodies Versus Ezetimibe in Real-World Settings

Muntner,

Ghazi,

Jones

et al. 2024

Adv Ther

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Introduction The cardiovascular disease risk reduction benefits of proprotein convertase subtilisin/kexin type 9 inhibitor monoclonal antibodies (PCSK9i mAb) and ezetimibe are dependent on remaining on treatment and being persistent and adherent. We estimated the percentage of patients on therapy, persistent and adherent at 182 and 365 days among US adults with health insurance who initiated a PCSK9i mAb ( n = 16,588) or ezetimibe ( n = 83,086) between July 2015 and December 2019. Methods Using pharmacy fill claims, being on therapy was defined as having a day of medication supply in the last 60 of 182 and 365 days following treatment initiation, being persistent was defined as not having a gap of 60 days or more between the last day of supply from one prescription fill and the next fill, and being adherent was defined by having medication available to take on ≥ 80% of the 182 and 365 days following treatment initiation. We estimated multivariable-adjusted risk ratios for being persistent and adherent comparing patients initiating PCSK9i mAb versus ezetimibe using Poisson regression. Results At 182 days following initiation, 80% and 68% were on therapy and 76% and 64% were persistent among patients who initiated a PCSK9i mAb and ezetimibe, respectively. Among patients who were on therapy and persistent at 182 days following initiation, 88% and 81% of those who initiated a PCSK9i mAb and ezetimibe, respectively, were on therapy at 365 days. Among those on therapy and persistent at 182 days following initiation, being persistent and being adherent at 365 days were each more common among PCSK9i mAb versus ezetimibe initiators (persistent: 82% versus 76%, multivariable-adjusted risk ratio 1.07; 95% confidence interval [CI] 1.06–1.08; adherent: 74% versus 71%, multivariable-adjusted risk ratio 1.02; 95% CI 1.01–1.03). Conclusions These data suggest approaches to increase persistence and adherence to PCSK9i mAb and ezetimibe should be implemented prior to or within 182 days following treatment initiation. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-024-02868-z.

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Relation Between Cardiology Follow-Up Visits, Evidence-Based Statin Prescribing, and Statin Adherence (from the Veterans Affairs Health Care System)

Cited by 7 publications

References 26 publications

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

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

Statin Use in Older Adults for Primary Cardiovascular Disease Prevention Across a Spectrum of Cardiovascular Risk

Persistence and Adherence to PCSK9 Inhibitor Monoclonal Antibodies Versus Ezetimibe in Real-World Settings

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