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Vasc Med. 2018 Jun;23(3):232-240. doi: 10.1177/1358863X18758914. Epub 2018 Mar 30.

Statin prescription rates and their facility-level variation in patients with peripheral artery disease and ischemic cerebrovascular disease: Insights from the Department of Veterans Affairs.

Author information

1
1 Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
2
2 Health Policy, Quality & Informatics Program, Michael E DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations; and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
3
3 Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
4
4 The Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
5
5 Section of Cardiology, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
6
6 Center for Healthcare Advancement & Outcomes at Baptist Health South Florida, Miami, FL, USA.
7
7 The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
8
8 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
9
9 Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
10
10 Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
11
11 Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA.
12
12 Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.

Abstract

The 2013 American College of Cardiology/American Heart Association cholesterol guideline recommends moderate to high-intensity statin therapy in patients with peripheral artery disease (PAD) and ischemic cerebrovascular disease (ICVD). We examined frequency and facility-level variation in any statin prescription and in guideline-concordant statin prescriptions in patients with PAD and ICVD receiving primary care in 130 facilities across the Veterans Affairs (VA) health care system between October 2013 and September 2014. Guideline-concordant statin intensity was defined as the prescription of high-intensity statins in patients with PAD or ICVD ≤75 years and at least moderate-intensity statins in those >75 years. We calculated median rate ratios (MRR) after adjusting for patient demographic factors to assess the magnitude of facility-level variation in statin prescribing patterns independent of patient characteristics. Among 194,151 PAD patients, 153,438 patients (79.0%) were prescribed any statin and 79,435 (40.9%) were prescribed a guideline-concordant intensity of statin. PAD patients without ischemic heart disease were prescribed any statin and a guideline-concordant intensity of statin therapy less frequently (69.1% and 28.9%, respectively). Among 339,771 ICVD patients, 265,491 (78.1%) were prescribed any statin and 136,430 (40.2%) were prescribed a guideline-concordant intensity of statin. ICVD patients without ischemic heart disease were prescribed any statin and a guideline-concordant intensity of statin less frequently (70.9% and 30.5%, respectively). MRRs for both PAD and ICVD patients demonstrated a 20% and 28% variation among two facilities in treating two identical patients with statin therapy and guideline-concordant intensity of statin therapy, respectively. The prescription of statins, especially guideline-recommended intensity of statin therapy, is suboptimal in PAD and ICVD patients, with significant facility-level variation not explained by patient-level factors.

KEYWORDS:

cerebrovascular disease; disease prevention; lipids; other pharmacotherapy; peripheral artery disease (PAD); population health; practice guidelines; quality improvement; statins

PMID:
29600737
DOI:
10.1177/1358863X18758914
[Indexed for MEDLINE]

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