Patient-Reported Reasons for Not Using Primary Prevention Statin Therapy.

Cassandra M Dewitt,Robert B Ponce,Joseph A Ladapo,Hayley Bry,Erica Sedlander,Soma Wali

doi:10.3390/jcm9103337

Abstract

Almost half of patients who meet American College of Cardiology/American Heart Association (ACC/AHA) criteria for statin therapy are untreated. We aimed to evaluate patient-reported reasons for not using guideline-recommended statin therapy in a public healthcare system. Achieving this goal is key to addressing gaps in care and reducing preventable cardiovascular morbidity. We surveyed patients who met 2013 ACC/AHA guidelines for statin therapy but were not using statins. The survey probed domains of patient knowledge regarding cardiovascular health and benefits of statins, barriers to use, physician trust, and interest in cardiovascular care. Among 71 patients eligible for guideline-recommended statin therapy but not currently taking statins, 49 (69%) had a high school education or lower, 41 (58%) reported that they were unaware they should be prescribed a statin and 49 (69%) were unaware of the benefits of statins. Almost all patients, 70 (99%), reported caring about their cardiovascular health, 61 (86%) reported that they had a high level of trust in their physician, and 51 (72%) reported a willingness to follow their physician’s advice. Despite interest in cardiovascular health, awareness of benefits of statin therapy was low and knowledge of recommended statin therapy was low. Increasing patients’ awareness of their eligibility through systematic testing and linkage to statin therapy, along with education, may increase statin use among patients recommended for therapy.

Highlights

Statin therapy reduces the risk of major adverse cardiovascular events
We developed survey questions to address four domains that we hypothesized may contribute to the absence of statin therapy in patients who meet 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for treatment
We found that half of the patients not receiving guideline-recommended statin therapy for primary prevention were unaware that they were candidates for therapy, and 49 (69%) were unaware that a statin could lower their risk of having an adverse cardiovascular event or dying

Summary

Introduction

The 2013 American Heart Association/American College of Cardiology (AHA/ACC) guidelines recommend statin therapy for adults with clinical atherosclerotic cardiovascular disease (ASCVD), LDL-C levels of 190 mg per dL or greater, a diagnosis of diabetes mellitus, and LDL-C levels of 70 mg per dL or greater, or a 10-year ASCVD risk of 7.5% or greater. These guidelines increased the proportion of United States (U.S.) adults recommended for therapy from 43.2 million (35.5%) to 56 million (48.6%) [1,2,3,4]. While most prior research has focused on patients who discontinued statin therapy, less is known about why patients may never have even been initiated on statin therapy

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Conclusion