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Relation Between Cardiology Follow-Up Visits, Evidence-Based Statin Prescribing, and Statin Adherence (from the Veterans Affairs Health Care System) - 18/09/19

Doi : 10.1016/j.amjcard.2019.07.022 
Hasan Rehman, MD a, 1, Sarah T. Ahmed, MBBS MPH b, c, 1, Julia Akeroyd, MPH b, c, Dhruv Mahtta, MD d, Xiaoming Jia, MD e, Mahmoud Al Rifai, MD MPH f, Khurram Nasir, MD MPH g, Hani Jneid, MD h, Mirza U. Khalid, MD h, Mahboob Alam, MD h, Peter P. Toth, MD, PhD i, j, Salim S. Virani, MD PhD b, c, e, k,
a Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas 
b Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, Texas 
c Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas 
d Department of Medicine, University of Florida, Gainesville, Florida 
e Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas 
f Department of Medicine, University of Kansas School of Medicine, Wichita, Kankas 
g Division of Cardiovascular Medicine, Center for Outcomes & Research Evaluation (CORE), Yale University School of Medicine & Yale New Haven Health, New Haven, Connecticut 
h Department of Medicine, Division of Cardiology, Baylor College of Medicine Houston, Texas 
i Clinical Family and Community Medicine, University of Illinois College of Medicine, Peoria, Illinois 
j Department of Medicine, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan 
k Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas 

Corresponding author: Tel: (713) 440-4410; fax: (713) 748-7359.

Résumé

Statin use remains suboptimal in patients with atherosclerotic cardiovascular disease (ASCVD). We assessed whether outpatient care with a cardiology provider is associated with evidence-based statin prescription and statin adherence. We identified patients with ASCVD aged ≥18 years receiving primary care in 130 facilities and associated community-based outpatient clinics in the entire Veterans Affairs Health Care System between October 1, 2013 and September 30, 2014. Patients were divided into: (1) patients with at least 1 outpatient cardiology visit and (2) patients with no outpatient cardiology visits in the year before the index primary care visit. We assessed any- and high-intensity statin prescription adjusting for several patient- and facility-level covariates, and statin adherence using proportion of days covered (PDC). We included 1,249,061 patients with ASCVD (mean age: 71.9 years; 98.0% male). After adjusting for covariates, patients who visited a cardiology provider had greater odds of being on a statin (87.4% vs 78.4%; Odds ratio [OR] 1.25, 95% Confidence interval [CI] 1.24 to 1.26), high-intensity statin (34.5% vs 21.2%; OR: 1.21, 95% CI 1.21 to 1.22), and higher statin adherence (mean PDC 0.76 ± 0.29 vs 0.70 ± 0.34, PDC ≥0.8: 62.0% vs 57.3%; OR 1.09, 95% CI 1.09 to 1.11). A dose response relation was seen with a higher number of cardiology visits associated with a higher statin use and statin adherence. In conclusion, compared with outpatient care delivered by primary care providers alone, care delivered by a cardiology provider for patients with ASCVD is associated with a higher likelihood of guideline-based statin use and statin adherence.

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 Funding: This work was supported by a Department of Veterans Affairs Health Services Research & Development Service Investigator Initiated Grant (IIR 16–072), an American Heart Association Beginning Grant-in-Aid (14BGIA20460366), the American Diabetes Association Clinical Science and Epidemiology award (1-14-CE-44), and the Houston VA Health Services Research & Development Center for Innovations grant (CIN13-413)
 The opinions expressed reflect those of the authors and not necessarily those of the Department of Veterans Affairs or the US government.


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Vol 124 - N° 8

P. 1165-1170 - octobre 2019 Retour au numéro
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