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

Cameron L. McBride, Julia M. Akeroyd, David J. Ramsey, Vijay Nambi, Khurram Nasir, Erin Donnelly Michos, Ruth L. Bush, Hani Jneid, Pamela B. Morris, Vera A. Bittner, Christie M. Ballantyne, Laura A. Petersen, Salim S. Virani

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalVascular Medicine (United Kingdom)
DOIs
StateAccepted/In press - Mar 1 2018

Fingerprint

Cerebrovascular Disorders
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Peripheral Arterial Disease
Veterans
Prescriptions
Guidelines
Myocardial Ischemia
Veterans Health
Therapeutics

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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. / McBride, Cameron L.; Akeroyd, Julia M.; Ramsey, David J.; Nambi, Vijay; Nasir, Khurram; Michos, Erin Donnelly; Bush, Ruth L.; Jneid, Hani; Morris, Pamela B.; Bittner, Vera A.; Ballantyne, Christie M.; Petersen, Laura A.; Virani, Salim S.

In: Vascular Medicine (United Kingdom), 01.03.2018.

Research output: Contribution to journalArticle

McBride, Cameron L. ; Akeroyd, Julia M. ; Ramsey, David J. ; Nambi, Vijay ; Nasir, Khurram ; Michos, Erin Donnelly ; Bush, Ruth L. ; Jneid, Hani ; Morris, Pamela B. ; Bittner, Vera A. ; Ballantyne, Christie M. ; Petersen, Laura A. ; Virani, Salim S. / 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. In: Vascular Medicine (United Kingdom). 2018.
@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 Donnelly} 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.}",
year = "2018",
month = "3",
day = "1",
doi = "10.1177/1358863X18758914",
language = "English (US)",
journal = "Vascular Medicine",
issn = "1358-863X",
publisher = "SAGE Publications Ltd",

}

TY - JOUR

T1 - Statin prescription rates and their facility-level variation in patients with peripheral artery disease and ischemic cerebrovascular disease

T2 - Insights from the Department of Veterans Affairs

AU - McBride, Cameron L.

AU - Akeroyd, Julia M.

AU - Ramsey, David J.

AU - Nambi, Vijay

AU - Nasir, Khurram

AU - Michos, Erin Donnelly

AU - Bush, Ruth L.

AU - Jneid, Hani

AU - Morris, Pamela B.

AU - Bittner, Vera A.

AU - Ballantyne, Christie M.

AU - Petersen, Laura A.

AU - Virani, Salim S.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - 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.

AB - 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.

KW - cerebrovascular disease

KW - disease prevention

KW - lipids

KW - other pharmacotherapy

KW - peripheral artery disease (PAD)

KW - population health

KW - practice guidelines

KW - quality improvement

KW - statins

UR - http://www.scopus.com/inward/record.url?scp=85044927617&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044927617&partnerID=8YFLogxK

U2 - 10.1177/1358863X18758914

DO - 10.1177/1358863X18758914

M3 - Article

JO - Vascular Medicine

JF - Vascular Medicine

SN - 1358-863X

ER -