Practice-level variation in statin use and low-density lipoprotein cholesterol control in the United States: Results from the Patient and Provider Assessment of Lipid Management (PALM) registry

Michael G Nanna; Ann Marie Navar; Tracy Y Wang; Shuang Li; Salim S Virani; Zhuokai Li; Jennifer G Robinson; Veronique L Roger; Peter W F Wilson; Anne C Goldberg; Andrew Koren; Michael J Louie; Eric D Peterson

doi:10.1016/j.ahj.2019.05.009

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Practice-level variation in statin use and low-density lipoprotein cholesterol control in the United States: Results from the Patient and Provider Assessment of Lipid Management (PALM) registry

Journal article

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Practice-level variation in statin use and low-density lipoprotein cholesterol control in the United States: Results from the Patient and Provider Assessment of Lipid Management (PALM) registry

Michael G Nanna, Ann Marie Navar, Tracy Y Wang, Shuang Li, Salim S Virani, Zhuokai Li, Jennifer G Robinson, Veronique L Roger, Peter W F Wilson, Anne C Goldberg, …

The American heart journal, Vol.214, pp.113-124

08/2019

DOI: 10.1016/j.ahj.2019.05.009

PMCID: PMC6639125

PMID: 31202098

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Abstract

Adherence to guideline-recommended statin recommendations in the United States is suboptimal. Patients' likelihood to be treated according to guidelines may vary by the practice in which they are treated. Variation in the use of statin therapy in 5445 patients, with known or at high risk for atherosclerotic cardiovascular disease (ASCVD) and meeting a statin treatment indication, was examined across 74 US Patient and Provider Assessment of Lipid Management (PALM) Registry clinics. Multivariable generalized linear mixed modeling was used to determine the median odds ratio (MOR) for statin use and 2013 American College of Cardiology/American Heart Association guideline-recommended statin intensity by practice. MOR quantifies between-practice variation by comparing the odds of receiving guideline-recommended statin treatment in a patient from a randomly selected practice with a similar patient from another random practice. Risk-adjusted low-density lipoprotein cholesterol (LDL-C) control (<100 and <70 mg/dL) was compared among practice tertiles based on percentage of eligible patients receiving recommended statin intensity. Among 74 practices (43.2% cardiology) comprised of 300 healthcare providers enrolling 5445 patients (56.2% with ASCVD), statin use at the guideline-recommended intensity at practices varied widely (12.7-71.4%; adjusted MOR 1.45, 95% confidence interval [CI] 1.35-1.64). Results were consistent when evaluated for any statin use overall (adjusted MOR 1.75, 95% CI 1.48-1.99) and when stratified by primary versus secondary prevention patients. Relative to practices with lowest or mid-tertile statin use of statins, highest tertile clinics were more frequently cardiology practices (68.0% vs 48.0% vs 12.5%, P < .001). Compared with lowest tertile clinics, patients at highest tertile clinics were more likely to achieve LDL-C <70 mg/dL (adjusted odds ratio [OR] 1.49, 95% CI 1.08-2.04) and <100 mg/dL (adjusted OR 1.78, 95% CI 1.41-2.25). US clinics varied widely in their adherence to guideline recommendations for statin therapy, which contributed to significant differences in LDL-C levels.

United States

Multivariate Analysis

Primary Prevention

Atherosclerosis - drug therapy

Guideline Adherence - statistics & numerical data

Humans

Practice Patterns, Physicians

Secondary Prevention

Atherosclerosis - blood

Registries - statistics & numerical data

Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use

Cardiology - statistics & numerical data

Cholesterol, LDL - blood

Odds Ratio

Atherosclerosis - prevention & control

Details

Title: Subtitle: Practice-level variation in statin use and low-density lipoprotein cholesterol control in the United States: Results from the Patient and Provider Assessment of Lipid Management (PALM) registry
Creators: Michael G Nanna - Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. Electronic address: michael.nanna@duke.edu
Ann Marie Navar - Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
Tracy Y Wang - Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
Shuang Li - Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
Salim S Virani - Baylor College of Medicine, Houston, TX
Zhuokai Li - Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
Jennifer G Robinson - The University of Iowa College of Public Health, Iowa City, IA
Veronique L Roger - Mayo Clinic, Rochester, MN
Peter W F Wilson - Atlanta Veterans Affairs Medical Center and Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
Anne C Goldberg - Washington University in St. Louis
Andrew Koren - Sanofi, Bridgewater, NJ
Michael J Louie - Regeneron Pharmaceuticals, Inc., Tarrytown, NY
Eric D Peterson - Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
Resource Type: Journal article
Publication Details: The American heart journal, Vol.214, pp.113-124
Publisher: United States
DOI: 10.1016/j.ahj.2019.05.009
PMID: 31202098
PMCID: PMC6639125
ISSN: 0002-8703
eISSN: 1097-6744
Grant note: K01 HL133416 / NHLBI NIH HHS T32 HL069749 / NHLBI NIH HHS
Language: English
Date published: 08/2019
Academic Unit: Epidemiology; Internal Medicine
Record Identifier: 9983995180202771

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