Guideline Concordance of Statin Treatment Decisions: A Retrospective Cohort Study.

Yael Rachamin,Thomas Rosemann,Rahel Meier,Thomas Grischott,Stefan Markun

doi:10.3390/jcm9113719

Abstract

Guidelines recommend initiation of statins depending on cardiovascular risk and low-density lipoprotein cholesterol (LDL-C) levels. In this retrospective cohort study, we aimed to assess guideline concordance of statin treatment decisions and to find determinants of undertreatment in Swiss primary care in the period 2016–2019. We drew on electronic medical records of 8060 statin-naive patients (50.0% female, median age 59 years) with available LDL-C levels and cardiovascular risk. Guideline concordance was assessed based on the recommendations of the European Society of Cardiology, and multilevel logistic regression was performed to find determinants of undertreatment. We found that statin treatment was initiated in 10.2% of patients during one year of follow up. Treatment decisions were classified as guideline-concordant in 63.0%, as undertreatment in 35.8% and as overtreatment in 1.2%. Among determinants of undertreatment were small deviation from LDL-C treatment thresholds (odds ratio per decrease by 1 mmol/L: 2.09 [95% confidence interval 1.87–2.35]), high compared with very high cardiovascular risk (1.64 [1.30–2.05]), female sex (1.31 [1.05–1.64]), and being treated by older general practitioners (per 10 year decrease: 0.74 [0.61–0.90]). In conclusion, undertreatment of patients at high or very high cardiovascular risk was common, but general practitioners considered cardiovascular risk and LDL-C in their treatment decisions.

Highlights

Cardiovascular (CV) diseases are the major cause of death globally, responsible for 31% of worldwide deaths and 45% of deaths in Europe [1,2]
For patients who were initiated on a statin, the median time interval from the index low-density lipoprotein cholesterol (LDL-C) measurement to statin initiation was 25 days (IQR = 0–169) and the median time span from the last LDL-C measurement to statin initiation was 6 days (IQR = 0–68)
The treatment intensity of the first statin prescription was low in 2.1% (n = 17), moderate in 56.3% (n = 462) and high in 36.5% (n = 300); for 6% of patients, treatment intensity was missing

Summary

Introduction

Cardiovascular (CV) diseases are the major cause of death globally, responsible for 31% of worldwide deaths and 45% of deaths in Europe [1,2]. Low-density lipoprotein cholesterol (LDL-C), are among the major risk factors for CV diseases [3]. To decrease the risk of fatal CV disease, guidelines suggest lowering LDL-C levels [4,5], and statins are the first-line therapy to achieve this goal [6]. Recommendations for the initiation of statins depend on CV risk and directly on LDL-C levels because lowering LDL-C levels is most relevant for patients at increased CV risk [4]

Objectives

Results

Conclusion