Abstract
BackgroundInitiation of statins for the primary prevention of cardiovascular disease (CVD) should be based on CVD risk estimates, but their use is suboptimal.AimTo investigate the factors influencing statin prescribing when clinicians code and do not code estimated CVD risk (QRISK2).Design and settingA historical cohort of patients who had lipid tests in a database (IQVIA Medical Research Data) of UK primary care records.MethodThe cohort comprised 686 560 entries (lipid test results) between 2012 and 2016 from 383 416 statin-naive patients without previous CVD. Coded QRISK2 scores were extracted, with variables used in calculating QRISK2 and factors that might influence statin prescribing. If a QRISK2 score was not coded, it was calculated post hoc. The outcome was initiation of a statin within 60 days of the lipid test result.ResultsOf the entries, 146 693 (21.4%) had a coded QRISK2 score. Statins were initiated in 6.6% (95% confidence interval [CI] = 6.4% to 6.7%) of those with coded and 4.1% (95% CI = 4.0% to 4.1%) of uncoded QRISK2 (P<0.001). Statin initiations were consistent with National Institute for Health and Care Excellence guideline recommendations in 85.0% (95% CI = 84.2% to 85.8%) of coded and 44.2% (95% CI = 43.5% to 44.9%) of uncoded QRISK2 groups (P<0.001). When coded, QRISK2 score was the main predictor of statin initiation, but total cholesterol was the main predictor when a QRISK2 score was not coded.ConclusionWhen a QRISK2 score is coded, prescribing is more consistent with guidelines. With no QRISK2 score, prescribing is mainly based on total cholesterol. Using QRISK2 is associated with statin prescribing that is more likely to benefit patients. Promoting the routine CVD risk estimation is essential to optimise decision making.
Highlights
Statins are the most prescribed class of medicine in England[1] with >70 million statin prescriptions issued each year,[2] and they play an important role in the primary prevention of cardiovascular disease (CVD)
With no QRISK2 score, prescribing is mainly based on total cholesterol
Using QRISK2 is associated with statin prescribing that is more likely to benefit patients
Summary
Statins are the most prescribed class of medicine in England[1] with >70 million statin prescriptions issued each year,[2] and they play an important role in the primary prevention of cardiovascular disease (CVD). The estimation of CVD risk is a fundamental part of clinical guidance on CVD prevention around the world.[4,5,6,7] In England and Wales, the risk threshold for offering treatment was a 20% 10-year risk until 2014, when it was lowered to a 10% 10-year risk.[7,8] The effective utilisation of risk scoring improves accuracy of CVD risk predictions and increases medical prescribing with no evidence of clinical harm.[9,10,11] because communication of the risks and benefits of treatment options is a necessary component of shared decision making, an accurate CVD risk estimate is an essential part of effective clinical decision making. Initiation of statins for the primary prevention of cardiovascular disease (CVD) should be based on CVD risk estimates, but their use is suboptimal
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: The British journal of general practice : the journal of the Royal College of General Practitioners
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
