Pcv92 Improving Members Hypertension at Blue Cross Blue Shield of Louisiana: The Effectiveness of Ochsner's Digital Medicine Hypertension (Dmh) Program

Abstract

Objectives: Statins are effective in reducing low-density lipoprotein cholesterol (LDL-C) and cardiovascular disease risk, however, despite treatment, patients in the real-world setting may not reach lipid goals. Ensuring timely treatment intensification (TI) is important in reducing the risk of adverse outcomes. The objectives of this study, conducted in patients with ASCVD and baseline LDL-C.70 despite existing statin therapy were to (a) To evaluate predictors of TI (b) To assess the association between TI and LDL-C lowering. Methods: A retrospective cohort study was conducted using Truven MarketScan database from 2013-2017. The first prescription of statin between January 2014-February 2016 was identified as the index date. A preindex period of 180 days to identify baseline characteristics and a follow-up period of 360 days for outcomes was determined. TI was defined as an increase in the intensity of statin from low to moderate, moderate to high or low to high. Logistic regression was conducted to identify predictors of TI. To measure the effect of TI on LDL-C reduction, multiple linear regression with follow-up LDL-C as the outcome was performed. Results: There were 14,395 patients included in the study with 3,909 patients having follow-up LDL-C values. TI in the follow-up was observed in 1,914 (13.30%) patients. Age older than 75 [OR: 0.7(95%CI: 0.59-0.84)] was associated with lower likelihood of TI in the multivariable logistic regression model. Baseline characteristics positively associated with TI included higher LDL-C value and adherence, low and moderate statin intensity, male sex and diabetes. For patients with follow-up LDL-C values, TI was associated with significant mean reduction in LDL-C (b: -9.68, p=,0.0001). Conclusions: Even though TI was associated with significant LDL-C lowering, a significant proportion of patients not at goal were not intensified. Future studies need to examine the relationship of TI with factors such as patient adherence and side-effects as well as cardiovascular outcomes.