Variation in statin prescription among veterans with HIV and known atherosclerotic cardiovascular disease

Sebhat Erqou, Alexa Papaila, Christopher Halladay, Augustus Ge, Michael A. Liu, Lan Jiang, Michelle Lally, Anupama Menon, Nishant R. Shah, Edward Miech, Salim S. Virani, Andrew R. Zullo, Theresa I. Shireman, Christopher T. Longenecker, David Ross, Jennifer L. Sullivan, Wen Chih Wu, James L. Rudolph

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Background: People with HIV have increased atherosclerotic cardiovascular disease (ASCVD) risk, worse outcomes following incident ASCVD, and experience gaps in cardiovascular care, highlighting the need to improve delivery of preventive therapies in this population. Objective: Assess patient-level correlates and inter-facility variations in statin prescription among Veterans with HIV and known ASCVD. Methods: We studied Veterans with HIV and existing ASCVD, ie, coronary artery disease (CAD), ischemic cerebrovascular disease (ICVD), and peripheral arterial disease (PAD), who received care across 130 VA medical centers for the years 2018-2019. We assessed correlates of statin prescription using two-level hierarchical multivariable logistic regression. Median odds ratios (MORs) were used to quantify inter-facility variation in statin prescription. Results: Nine thousand six hundred eight Veterans with HIV and known ASCVD (mean age 64.3 ± 8.9 years, 97% male, 48% Black) were included. Only 68% of the participants were prescribed any-statin. Substantially higher statin prescription was observed for those with diabetes (adjusted odds ratio [OR] = 2.3, 95% confidence interval [CI], 2.0-2.6), history of coronary revascularization (OR = 4.0, CI, 3.2-5.0), and receiving antiretroviral therapy (OR = 3.0, CI, 2.7-3.4). Blacks (OR = 0.7, CI, 0.6-0.9), those with non-coronary ASCVD, ie, ICVD and/or PAD only, (OR 0.53, 95% CI: 0.48-0.57), and those with history of illicit substance use (OR=0.7, CI, 0.6-0.9) were less likely to be prescribed statins. There was significant variation in statin prescription across VA facilities (10th, 90th centile: 55%, 78%), with an estimated 20% higher likelihood of difference in statin prescription practice for two clinically similar individuals treated at two comparable facilities (adjusted MOR = 1.21, CI, 1.18-1.24), and a greater variation observed for Blacks or those with non-coronary ASCVD or history of illicit drug use. Conclusion: In an analysis of large-scale VA data, we found suboptimal statin prescription and significant interfacility variation in statin prescription among Veterans with HIV and known ASCVD, particularly among Blacks and those with a history of non-coronary ASCVD.

Original languageEnglish
Pages (from-to)12-22
Number of pages11
JournalAmerican Heart Journal
Volume249
DOIs
Publication statusPublished - Jul 2022
Externally publishedYes

Keywords

  • CVD
  • Cardiovascular disease
  • HIV
  • Health care quality
  • Health services
  • Human immunodeficiency virus
  • Statin

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