Background: This study assessed lipid-monitoring and statin therapy patterns in routine clinical practice for Medicare-eligible patients diagnosed with atherosclerosis.
Methods: A retrospective study using a random sample of 1 million patients (>17 years of age) from a US outpatient electronic medical record database was conducted with patients > or =65 years of age having a diagnostic code for atherosclerosis between January 2004 and March 2006. Use of statin therapy at the time of and for 12 months after atherosclerosis diagnosis, in addition to patient demographics, comorbid conditions, baseline and post-diagnosis LDL-C, were recorded.
Results: In the million-patient sample, 3303 patients were > or =65 years of age and had a diagnostic code of atherosclerosis. Overall, 63% of these patients were not prescribed statin therapy at the time of or within 12 months after diagnosis. Lipid monitoring within 6 months before diagnosis occurred in 37% of patients. Of those with a recorded baseline LDL-C (n = 1213), 50% had LDL-C > or =100 mg/dL and 87% had LDL-C > or =70 mg/dL. Among patients with baseline LDL-C > or =100 mg/dL, 55% were not prescribed statin therapy at or after their diagnosis compared with 49% of patients with baseline LDL-C <100 mg/dL (p = 0.0001). There were significantly more patients who were prescribed statin therapy with LDL-C <100 mg/dL after diagnosis (67%) than at diagnosis (55%) (p = 0.0008).
Limitations: Patients were required to have an ICD-9 diagnosis of atherosclerosis, which may have underestimated those with atherosclerosis that was not coded specifically as atherosclerosis. Because the study included patients treated in physician practice with an electronic medical record system (EMR), they may be different from patients who are treated by physicians not equipped with an EMR. Pharmacy data were the prescription ordered and not the drug claim indicating that the prescription was dispensed. This may overestimate the statin therapy utilization estimates.
Conclusions: A substantial gap in the management of diagnosed atherosclerosis was found among Medicare-eligible patients treated in the usual-care setting. There is a need to raise awareness of the importance of lipid monitoring and treatment of hypercholesterolemia in this at-risk population.