TY - JOUR
T1 - Significant Facility-Level Variation in Utilization of and Adherence with Secondary Prevention Therapies Among Patients with Premature Atherosclerotic Cardiovascular Disease
T2 - Insights from the VITAL (Veterans wIth premaTure AtheroscLerosis) Registry7
AU - Mahtta, Dhruv
AU - Lee, Michelle T.
AU - Ramsey, David J.
AU - Akeroyd, Julia M.
AU - Krittanawong, Chayakrit
AU - Khan, Safi U.
AU - Sinh, Preetika
AU - Alam, Mahboob
AU - Garratt, Kirk N.
AU - Schofield, Richard S.
AU - Ballantyne, Christie M.
AU - Petersen, Laura A.
AU - Virani, Salim S.
N1 - Publisher Copyright:
© 2021, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2022/2
Y1 - 2022/2
N2 - Purpose: We investigated facility-level variation in the use and adherence with antiplatelets and statins among patients with premature and extremely premature ASCVD. Methods: Using the 2014–2015 nationwide Veterans wIth premaTure AtheroscLerosis (VITAL) registry, we assessed patients with premature (age at first ASCVD event: males < 55 years, females < 65 years) and extremely premature ASCVD (< 40 years). We examined frequency and facility-level variation in any statin, high-intensity statin (HIS), antiplatelet use (aspirin, clopidogrel, ticagrelor, prasugrel, and ticlopidine), and statin adherence (proportion of days covered ≥ 0.8) across 130 nationwide VA healthcare facilities. Facility-level variation was computed using median rate ratios (MRR), a measure of likelihood that two random facilities differ in use of statins or antiplatelets and statin adherence. Results: Our analysis included 135,703 and 7716 patients with premature and extremely premature ASCVD, respectively. Across all facilities, the median (IQR) prescription rate of any statin therapy, HIS therapy, and antiplatelets among patients with premature ASCVD was 0.73 (0.70–0.75), 0.36 (0.32–0.41), and 0.77 (0.73–0.81), respectively. MRR (95% CI) for any statin use, HIS use, and antiplatelet use were 1.53 (1.44–1.60), 1.58 (1.49–1.66), and 1.49 (1.42–1.56), respectively, showing 53, 58, and 49% facility-level variation. The median (IQR) facility-level rate of statin adherence was 0.58 (0.55–0.62) and MRR for statin adherence was 1.13 (1.10–1.15), showing 13% facility-level variation. Similar median facility-level rates and variation were observed among patients with extremely premature ASCVD. Conclusions: There is suboptimal use and significant facility-level variation in the use of statin and antiplatelet therapy among patients with premature and extremely premature ASCVD. Interventions are needed to optimize care and minimize variation among young ASCVD patients.
AB - Purpose: We investigated facility-level variation in the use and adherence with antiplatelets and statins among patients with premature and extremely premature ASCVD. Methods: Using the 2014–2015 nationwide Veterans wIth premaTure AtheroscLerosis (VITAL) registry, we assessed patients with premature (age at first ASCVD event: males < 55 years, females < 65 years) and extremely premature ASCVD (< 40 years). We examined frequency and facility-level variation in any statin, high-intensity statin (HIS), antiplatelet use (aspirin, clopidogrel, ticagrelor, prasugrel, and ticlopidine), and statin adherence (proportion of days covered ≥ 0.8) across 130 nationwide VA healthcare facilities. Facility-level variation was computed using median rate ratios (MRR), a measure of likelihood that two random facilities differ in use of statins or antiplatelets and statin adherence. Results: Our analysis included 135,703 and 7716 patients with premature and extremely premature ASCVD, respectively. Across all facilities, the median (IQR) prescription rate of any statin therapy, HIS therapy, and antiplatelets among patients with premature ASCVD was 0.73 (0.70–0.75), 0.36 (0.32–0.41), and 0.77 (0.73–0.81), respectively. MRR (95% CI) for any statin use, HIS use, and antiplatelet use were 1.53 (1.44–1.60), 1.58 (1.49–1.66), and 1.49 (1.42–1.56), respectively, showing 53, 58, and 49% facility-level variation. The median (IQR) facility-level rate of statin adherence was 0.58 (0.55–0.62) and MRR for statin adherence was 1.13 (1.10–1.15), showing 13% facility-level variation. Similar median facility-level rates and variation were observed among patients with extremely premature ASCVD. Conclusions: There is suboptimal use and significant facility-level variation in the use of statin and antiplatelet therapy among patients with premature and extremely premature ASCVD. Interventions are needed to optimize care and minimize variation among young ASCVD patients.
KW - ASCVD
KW - Adherence
KW - Antiplatelets
KW - Premature ASCVD
KW - Statins
KW - Variation
UR - http://www.scopus.com/inward/record.url?scp=85099022587&partnerID=8YFLogxK
U2 - 10.1007/s10557-020-07125-3
DO - 10.1007/s10557-020-07125-3
M3 - Article
C2 - 33400053
AN - SCOPUS:85099022587
SN - 0920-3206
VL - 36
SP - 93
EP - 102
JO - Cardiovascular Drugs and Therapy
JF - Cardiovascular Drugs and Therapy
IS - 1
ER -
