Adoption of the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline in Cardiology Practices Nationwide

Pokharel, Yashashwi; Tang, Fengming; Jones, Philip G.; Nambi, Vijay; Bittner, Vera; Hira, Ravi S.; Nasir, Khurram; Chan, Paul S.; Maddox, Thomas M.; Oetgen, William J.; Heidenreich, Paul A.; Borden, William B.; Spertus, John A.; Petersen, Laura A.; Ballantyne, Christie M.; Virani, Salim S.

doi:10.1001/jamacardio.2016.5922

Cited by 90 publications

(75 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Statin prescription was only noted in 62% of the patient cohort studied in REACH, and Berger et al documented the persistent underuse of statins in PAD patients treated at multispecialty outpatient clinics . Finally, an analysis examining the adoption of the 2013 ACC/AHA cholesterol guidelines described an underwhelming trend of moderate and high‐intensity statin use in a heterogeneous cohort of patients with clinical atherosclerotic cardiovascular disease—a 62.7% prescription rate before guideline publication compared with 67.0% rate after publication—signifying only a modest improvement . Collectively, while these prior studies have historically emphasized an overall underuse of statins in patients with PAD, these data may reflect the practice of physicians who were not explicitly considering how best to manage patients with PAD.…”

Section: Discussionmentioning

confidence: 99%

“…When describing variability in statin intensification rates there was dramatic variability across sites, even after adjusting for country and patient‐level factors, that was largely unexplained. Prior work suggests that there are many reasons healthcare providers may miss the opportunity to appropriately intensify statin therapy: lack of clinician familiarity with the 2013 ACC/AHA guidelines, clinician disagreement with guideline recommendations, and medical and patient‐centered contraindications to statin eligibility . In the case of PAD, where multiple disciplines can be treating the disease, there may be an unclear understanding about who should be responsible for initiating the statin intensification for patients with PAD.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Guideline‐directed statin intensification in patients with new or worsening symptoms of peripheral artery disease

Khariton

Patel

Chan

et al. 2018

Clinical Cardiology

Self Cite

View full text Add to dashboard Cite

Background The ACC/AHA cholesterol guidelines recommend patients with peripheral artery disease (PAD) be treated with a moderate to high‐intensity statin. The extent to which patients with new or worsening PAD symptoms are offered guideline therapy is unknown. Hypothesis There is significant variability in rate of guideline‐directed statin intensification across clinical practices. Methods In the PORTRAIT registry, patterns of statin therapy were assessed in 1144 patients at 16 PAD specialty clinics between June 2011 and December 2015 before and after an evaluation for new or worsening claudication symptoms. We documented whether patients were treated with a guideline statin as well as the incidence of statin intensification. Statin intensification was defined as transitioning from no statin or low‐intensity statin to moderate or high‐intensity statin treatment. Patient factors associated with intensification were examined. Site and provider‐level variation in intensification was summarized using an adjusted median odds ratio (aMOR). Results Among 1144 patients, 810 (70.8%) were initially on guideline therapy compared to 334 (29.2%) that were not. In the latter, 103 (30.8%) received intensification following evaluation. Patients with typical symptoms displayed greater odds of intensification (OR 3.74; 95% CI: 1.23‐11.41) while older patients had lower odds of intensification (OR 0.60/decade; 95% CI: 0.41‐0.88). Site variability for statin intensification was observed across sites (aMOR = 3.15; 95% CI 1.22‐9.60, [P = 0.02]) but not providers (aMOR = 1.89; 95% CI 1.00‐3.90, [P = 0.14]). Conclusions Most patients evaluated at a PAD specialty clinic for new or worsening claudication symptoms arrived on guideline statin therapy. Only 31% not receiving appropriate therapy underwent statin intensification. These findings highlight an important opportunity to optimize medical therapy for patients with PAD.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Guideline‐directed statin intensification in patients with new or worsening symptoms of peripheral artery disease

Khariton

Patel

Chan

et al. 2018

Clinical Cardiology

Self Cite

View full text Add to dashboard Cite

show abstract

“…With the release of the 2013 ACC/AHA guideline, a larger population of patients in the United States are now indicated for statin treatment,15, 16, 17 but prior studies show a considerable number of patients who were either untreated or underdosed 18, 19. Core laboratory results for the PALM registry identified a group of adults with LDL‐C ≥190 mg/dL who may have been undiagnosed and untreated because LDL‐C levels had not been measured.…”

Section: Discussionmentioning

confidence: 99%

Measurement of Low‐Density Lipoprotein Cholesterol Levels in Primary and Secondary Prevention Patients: Insights From the PALM Registry

Lowenstern

Návar

et al. 2018

JAHA

Self Cite

View full text Add to dashboard Cite

BackgroundThe 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommended testing low‐density lipoprotein cholesterol (LDL‐C) to identify untreated patients with LDL‐C ≥190 mg/dL, assess lipid‐lowering therapy adherence, and consider nonstatin therapy. We sought to determine whether clinician lipid testing practices were consistent with these guidelines.Methods and ResultsThe PALM (Patient and Provider Assessment of Lipid Management) registry enrolled primary and secondary prevention patients from 140 US cardiology, endocrinology, and primary care offices in 2015 and captured demographic data, lipid treatment history, and the highest LDL‐C level in the past 2 years. Core laboratory lipid levels were drawn at enrollment. Among 7627 patients, 2787 (36.5%) had no LDL‐C levels measured in the 2 years before enrollment. Patients without chart‐documented LDL‐C levels were more often women, nonwhite, uninsured, and non–college graduates (all P<0.01). Patients without prior lipid testing were less likely to receive statin treatment (72.6% versus 76.0%; P=0.0034), a high‐intensity statin (21.5% versus 24.3%; P=0.016), nonstatin lipid‐lowering therapy (24.8% versus 27.3%; P=0.037), and had higher core laboratory LDL‐C levels at enrollment (median 97 versus 92 mg/dL; P<0.0001) than patients with prior LDL‐C testing. Of 166 individuals with core laboratory LDL‐C levels ≥190 mg/dL, 36.1% had no LDL‐C measurement in the prior 2 years, and 57.2% were not on a statin at the time of enrollment.ConclusionsIn routine clinical practice, LDL‐C testing is associated with higher‐intensity lipid‐lowering treatment and lower achieved LDL‐C levels.

show abstract

“…; Pokharel et al. ) change in the use of statins and nonstatin lipid‐lowering drugs. A study in the VA found somewhat larger changes in statin use but did not include all high‐risk patients, was limited to 6 months of postguideline data, and did not adjust for underlying trends in statin use (Rodriguez et al.…”

Section: Discussionmentioning

confidence: 99%

“…In a large national cardiology outpatient registry, the guideline change was associated with a modest increase in the use of moderate‐to‐high‐intensity statins among high‐risk patients (Pokharel et al. ). We extend and contextualize these prior results, finding that an administrative change designed to substitute one statin for another had a greater incidental effect on guideline‐concordant prescribing of moderate‐to‐high‐intensity statins than the release of the ACC/AHA guideline itself.…”

Section: Discussionmentioning

confidence: 99%

Effects of Guideline and Formulary Changes on Statin Prescribing in the Veterans Affairs

Markovitz

Holleman

Hofer

et al. 2017

Health Services Research

View full text Add to dashboard Cite

show abstract

Adoption of the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline in Cardiology Practices Nationwide

Abstract: Adoption of the 2013 ACC/AHA Cholesterol Management Guideline in cardiology practices was modest. Timely interventions are needed to improve guideline-concordant practice to reduce the burden of ASCVD.

Cited by 90 publications

References 30 publications

Guideline‐directed statin intensification in patients with new or worsening symptoms of peripheral artery disease

Guideline‐directed statin intensification in patients with new or worsening symptoms of peripheral artery disease

Measurement of Low‐Density Lipoprotein Cholesterol Levels in Primary and Secondary Prevention Patients: Insights From the PALM Registry

Effects of Guideline and Formulary Changes on Statin Prescribing in the Veterans Affairs

Contact Info

Product

Resources

About