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

Statin use remains suboptimal in patients with atherosclerotic cardiovascular disease (ASCVD). We assessed whether outpatient care with a cardiology provider is associated with evidence-based statin prescription and statin adherence. We identified patients with ASCVD aged ≥18 years receiving primary...

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Veröffentlicht in:The American journal of cardiology Jg. 124; H. 8; S. 1165 - 1170
Hauptverfasser: Rehman, Hasan, Ahmed, Sarah T., Akeroyd, Julia, Mahtta, Dhruv, Jia, Xiaoming, Rifai, Mahmoud Al, Nasir, Khurram, Jneid, Hani, Khalid, Mirza U., Alam, Mahboob, Toth, Peter P., Virani, Salim S.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Elsevier Inc 15.10.2019
Elsevier Limited
Schlagworte:
Aged
Ambulatory Care
Arteriosclerosis
Atherosclerosis
Atherosclerosis - drug therapy
Cardiology
Cardiology - statistics & numerical data
Cardiovascular disease
Cardiovascular diseases
Confidence intervals
Diabetes
Drug Prescriptions - statistics & numerical data
Ethnicity
Female
Follow-Up Studies
Guideline Adherence
Health care
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hypertension
Illnesses
Male
Medication Adherence
Office Visits - trends
Patients
Primary care
Regression analysis
Retrospective Studies
Statins
Studies
United States
United States Department of Veterans Affairs - statistics & numerical data
Variables
Veterans
United States
ISSN:0002-9149, 1879-1913, 1879-1913
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Zusammenfassung:Statin use remains suboptimal in patients with atherosclerotic cardiovascular disease (ASCVD). We assessed whether outpatient care with a cardiology provider is associated with evidence-based statin prescription and statin adherence. We identified patients with ASCVD aged ≥18 years receiving primary care in 130 facilities and associated community-based outpatient clinics in the entire Veterans Affairs Health Care System between October 1, 2013 and September 30, 2014. Patients were divided into: (1) patients with at least 1 outpatient cardiology visit and (2) patients with no outpatient cardiology visits in the year before the index primary care visit. We assessed any- and high-intensity statin prescription adjusting for several patient- and facility-level covariates, and statin adherence using proportion of days covered (PDC). We included 1,249,061 patients with ASCVD (mean age: 71.9 years; 98.0% male). After adjusting for covariates, patients who visited a cardiology provider had greater odds of being on a statin (87.4% vs 78.4%; Odds ratio [OR] 1.25, 95% Confidence interval [CI] 1.24 to 1.26), high-intensity statin (34.5% vs 21.2%; OR: 1.21, 95% CI 1.21 to 1.22), and higher statin adherence (mean PDC 0.76 ± 0.29 vs 0.70 ± 0.34, PDC ≥0.8: 62.0% vs 57.3%; OR 1.09, 95% CI 1.09 to 1.11). A dose response relation was seen with a higher number of cardiology visits associated with a higher statin use and statin adherence. In conclusion, compared with outpatient care delivered by primary care providers alone, care delivered by a cardiology provider for patients with ASCVD is associated with a higher likelihood of guideline-based statin use and statin adherence.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:0002-9149
1879-1913
1879-1913
DOI:10.1016/j.amjcard.2019.07.022