@article{3cb253d588ba4e1f90fd1f10a6683c7f,
title = "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",
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",
author = "McBride, {Cameron L.} and Akeroyd, {Julia M.} and Ramsey, {David J.} and Vijay Nambi and Khurram Nasir and Michos, {Erin D.} and Bush, {Ruth L.} and Hani Jneid and Morris, {Pamela B.} and Bittner, {Vera A.} and Ballantyne, {Christie M.} and Petersen, {Laura A.} and Virani, {Salim S.}",
note = "Funding Information: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Nambi reported receiving a research grant from Merck (paid to Baylor College of Medicine), reported serving as a consultant to and on an advisory board for Sanofi-Regeneron, reported receiving an honorarium for event adjudication for a clinical trial by Siemens Healthcare Diagnostics and reported holding provisional patent 61721475 entitled {\textquoteleft}Biomarkers to Improve Prediction of Heart Failure Risk{\textquoteright} filed by Baylor College of Medicine and Roche. Dr Morris reported serving as a consultant for Amgen, AstraZeneca, Sanofi-Regeneron and having received research funding from Amgen. Dr Nasir reported serving as a consultant for Sanofi-Regeneron and serving on the advisory board for Quest Diagnostics. Dr Michos reported receiving an honorarium for event adjudication for a clinical trial by Siemens Healthcare Diagnostics. Dr Bittner reported serving on steering committees (her institution [University of Alabama at Birmingham] was compensated) for the ODYSSEY trial (Sanofi-Regeneron) and for development of the CETP inhibitor (Eli Lilly), reported being national coordinator of the STRENGTH trial (AstraZeneca), reported serving on advisory boards for Eli Lilly and Amgen, reported being co-investigator on a University of Alabama School of Public Health–Amgen contract related to Medicare analyses, and reported holding the position of past local site principal investigator for a Pfizer Inc. Studies of PCSK9 Inhibition and the Reduction of Vascular Events (SPIRE) trial. Dr Ballantyne reported receiving grant and research support (all paid to Baylor College of Medicine) from Abbott Diagnostics, Amarin, Amgen, Eli Lilly, Esperion, Novartis, Pfizer Inc., Otsuka, Regeneron, Roche Diagnostics, Sanofi-Synthelabo, Takeda, National Institutes of Health, American Heart Association and American Diabetes Association, and reported serving as a consultant to Abbott Diagnostics, Amarin, Amgen, AstraZeneca, Eli Lilly, Esperion, Genzyme, Isis, Matinas BioPharma Inc., Merck, Novartis, Pfizer Inc., Regeneron, Roche, and Sanofi-Synthelabo. Dr Virani reported serving on the steering committee (with no financial remuneration) for the Patient and Provider Assessment of Lipid Management (PALM) Registry at the Duke Clinical Research Institute. Funding Information: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this work was supported by the American Heart Association Beginning Grant-in-Aid (14BGIA20460366) and the American Diabetes Association Clinical Science and Epidemiology award (1-14-CE-44). This work was also supported by the Houston VA HSR&D Center for Innovations grant (HFP 90-020) and the VA HSR&D Investigator Initiated Grant (IR 16-072). Publisher Copyright: {\textcopyright} 2018, {\textcopyright} The Author(s) 2018.",
year = "2018",
month = jun,
day = "1",
doi = "10.1177/1358863X18758914",
language = "English (US)",
volume = "23",
pages = "232--240",
journal = "Vascular Medicine (United Kingdom)",
issn = "1358-863X",
publisher = "SAGE Publications Ltd",
number = "3",
}