Factors Associated with Disparities in Appropriate Statin Therapy in an Outpatient Inner City Population

Abstract

Lipid-lowering therapies are essential for the primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). The aim of this study is to identify discrepancies between cholesterol management guidelines and current practice with a focus on statin treatment in an underserved population based in a large single urban medical center. Among 1042 reviewed records, we identified 464 statin-eligible patients. Age was 61.0 ± 10.4 years and 53.9% were female. Most patients were black (47.2%), followed by Hispanic (45.7%) and white (5.0%). In total, 82.1% of patients were prescribed a statin. An appropriate statin was not prescribed in 32.4% of statin-eligible patients who qualified based only on a 10-year ASCVD risk of ≥7.5%. After adjustment for gender and health insurance status, appropriate statin treatment was independently associated with age >55 years (OR = 4.59 (95% CI 1.09–16.66), p = 0.026), hypertension (OR = 2.38 (95% CI 1.29–4.38), p = 0.005) and chronic kidney disease (OR = 3.95 (95% CI 1.42–14.30), p = 0.017). Factors independently associated with statin undertreatment were black race (OR = 0.42 (95% CI 0.23–0.77), p = 0.005) and statin-eligibility based solely on an elevated 10-year ASCVD risk (OR = 0.14 (95% CI 0.07–0.25), p < 0.001). Hispanic patients were more likely to be on appropriate statin therapy when compared to black patients (86.8% vs. 77.2%). Statin underprescription is seen in approximately one out of five eligible patients and is independently associated with black race, younger age, fewer comorbidities and eligibility via 10-year ASCVD risk only. Hispanic patients are more likely to be on appropriate statin therapy compared to black patients.

Increasing statin prescription rates to prevent cardiovascular disease among high-risk populations: a quality improvement intervention centred on a novel interactive tool

“…In the preintervention group, a multivariate analysis, when adjusting for gender and insurance status, appropriate statin prescription correlated positively with older age, hypertension and CKD. 4 However, lower rates were noted for black race and a 10 -year ASCVD score of ≥7.5%. In the postintervention group, a similar multivariable analysis showed no correlation between appropriate statin prescription and black race or 10-year ASCVD score of ≥7.5%.…”

“… 2 3 In our previous retrospective analysis of 1042 consecutive patient encounters between August 2018 and August 2019 at our academic primary care practice, our data showed lower prescription rates among younger patients, those who identified as black, and those who met statin-eligibility solely via a 10-year ASCVD risk score ≥7.5%. 4 In order to improve adherence to cholesterol guidelines at our academic institution, a quality improvement (QI) project was undertaken between 1 July and 15 November 2020.…”

“…Specifically, statin underprescription was seen in approximately one out of five eligible patients and was independently associated with black race, younger age, fewer comorbidities and eligibility via 10-year ASCVD risk only. 4 As outlined in our methodology, the QI measures were executed in our clinic over a 4-month period during which each resident physician within the residency programme had spent a 2-week time period in the clinic. During this time period, the residents learnt about the guidelines and the interventions.…”

Nonadherence to lipid‐lowering therapy and strategies to improve adherence in patients with atherosclerotic cardiovascular disease

“…Healthcare disparities have been consistently reported in patterns of statin prescription and use, with differences based on race/ethnicity, sex, age, socioeconomic status, and co‐occurring vulnerabilities. 10 , 19 , 22 Data from the PALM registry showed that among patients recommended for statin therapy for secondary prevention but not being treated ( n = 566), 47.0% were never offered a statin by their provider. 9 Compared with patients on statin therapy, those who were never offered a statin were more likely to be female (51.1% vs. 39.4%; p < .001) and of Black (20.9% vs. 12.1%) or Hispanic (14.0% vs. 10.1%; p = .0005) ethnicity.…”

Black lives matter … in the cath lab, too! A proposal for the interventional cardiology community to counteract bias and racism

“…17 Racial disparities in the use of guideline-directed medical therapies in ACS have been documented previously. 18,19 Strategies to increase the proportion of Black patients discharged with guidelinedirected medications should help ameliorate these disparities. A "Meds to Beds" program that supplies medications to patients on the day of discharge has shown promise in individual and regional health systems.…”