Abstract 10788: Identifying Clinical and Demographic Factors Associated With Sub-Optimal Statin Prescription Rates Following Carotid Endarterectomy

Abstract

Introduction: Statin therapy is under prescribed in patients undergoing carotid endarterectomy (CEA). We determined new statin prescription rates following CEA as well as the demographic, clinical, and procedural characteristics associated with likelihood of new prescription. Methods: A retrospective Vascular Quality Initiative analysis of patients undergoing CEA and not on statin therapy pre-procedure between 2013 to 2021 was performed. Multivariate logistic regression was used to determine patient characteristics associated with new statin therapy. Results: Participants undergoing CEA were predominantly male (61%) and white (90%), with a mean age of 70.6 ± 9.1 years. Of all eligible subjects, 13.2% were not on statin therapy at time of CEA, corresponding to 15,733 procedures. New statin therapy was prescribed following 48% of these procedures, with rates increasing throughout the study period (36.2% in 2013 to 62% in 2021) (Figure). A higher likelihood of new statin prescription was associated with non-white race (Asian vs. White (Relative Risk (RR) 1.13; 95% Confidence Interval (CI) 1.06-1.20); Black vs. White (RR 1.26; 95% CI 1.11-1.43)), diabetes (oral medications vs. no diabetes (RR 1.06; 95% CI 1.02-1.11)), coronary heart disease (RR 1.12; 95% CI 1.08-1.16), prior stroke (RR 1.29; 95% CI 1.22-1.37), TIA (RR 1.07; 95% CI 1.00-1.13), and a non-elective indication (elective vs. emergent (RR 1.39; 95% CI 1.27-1.53)). A lower likelihood of new statin prescription was associated with older age (≥77 vs. ≤65 (RR 0.88; 95% CI 0.84-0.93)), female gender (RR 0.95; 95% CI 0.92-0.99), COPD (RR 0.95; 95% CI 0.91-0.99), and prior carotid revascularization (RR 0.87; 95% CI 0.82-0.92). Conclusions: A significant percentage of patients are not on a statin at the time of CEA, and of those, only 48% are discharged on one. System-wide and provider-focused efforts are needed to identify shortcomings in the introduction of this cardioprotective medication into standard of care.