System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Ahead of print

PubMed: 41717695 DOI: 10.1161/CIRCOUTCOMES.125.012622

Variation in Lipid Management for Atherosclerotic Cardiovascular Disease Across US Health Systems.

Circ Popul Health Outcomes

Authors: Nishant P Shah, Eric D Peterson, Peter Shrader, Satoshi Shoji, Nikki Freeman, Seth S Martin, Clint Allred, Soledad Fernandez, Alanna M Chamberlain, Jonathan Arnold, Michael D Shapiro, Mark B Effron, Elisa Priest, Mahanaz Syed, H Lester Kirchner, Monika Leja, Zahid Ahmad, Bethany Kalich, Ran Jin, Laney K Jones, Cezary Wojcik, Ann Marie Navar

Affiliations

  • Duke University School of Medicine, Durham, NC (N.P.S. S.S.).
  • Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (E.D.P. Z.A. A.M.N.).
  • Duke Clinical Research Institute, Durham, NC (P.S. S.S. N.F.).
  • Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (S.S.M.).
  • Department of Population Health, University of Utah, Salt Lake City (C.A.).
  • St Luke's Health Idaho Cardiology Associates, Boise (C.A.).
  • Department of Biomedical Informatics, Ohio State University, Columbus (S.F.).
  • Department of Quantitative Health Sciences, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.M.C.).
  • Department of Medicine, University of Pittsburgh School of Medicine, PA (J.A.).
  • Department of Cardiovascular Medicine, Wake Forest University Health Sciences, NC (M.D.S.).
  • Cardiology Department, Xavier Ochsner College of Medicine, New Orleans, LA (M.B.E.).
  • Baylor Scott & White Research Institute, Dallas, TX (E.P.).
  • Department of Population Health Sciences, University of Texas Health Science Center, San Antonio (M.S.).
  • Department of Population Health Sciences (H.L.K.), Geisinger Health, Danville, PA.
  • Department of Cardiovascular Medicine, University of Michigan, Ann Arbor (M.L.).
  • Amgen, Inc, Thousand Oaks, CA (B.K. R.J. C.W.).
  • Department of Genomic Health (L.K.J.), Geisinger Health, Danville, PA.

Abstract

BACKGROUND

While health systems have implemented resources to improve lipid management in people with atherosclerotic cardiovascular disease, the population-level effectiveness is unclear.

METHODS

Electronic health record data from patients with atherosclerotic cardiovascular disease between January 1, 2021, and December 31, 2023, across 16 US academic health systems were analyzed. Atherosclerotic cardiovascular disease (defined by diagnosis and procedure codes) was established on or before the index date defined as the date of the most recent LDL-C (low-density lipoprotein-cholesterol) or the last day of the study period for those without an LDL-C available. Systems were surveyed to identify lipid management programs (eg, prevention/lipid clinic, electronic health record-based tools, and lipid management algorithms). Sequential multilevel multivariable logistic regression modeling was used to (1) assess the system-level association between an LDL-C <70 mg/dL and the presence of lipid management programs, adjusting for patient-level demographic and clinical characteristics, and (2) whether system-level uptake of statin or nonstatin lipid-lowering therapy was associated with an LDL-C <70 mg/dL.

RESULTS

We included 1 738 042 patients with atherosclerotic cardiovascular disease (median, 88 365 per system; range, 17 086-2 48 371). About 81% of the health systems had prevention or lipid clinics. The proportion of those on statins ranged from 31.0% to 60.4% across health systems (median, 46.3%). Lower proportions were observed in the use of high-intensity statins (16.2%-33.1%), nonstatins (2.6%-8.1%), and combination lipid-lowering therapy (1.7%-6.3%). Among those with an LDL-C level available (n=890 521), 42.5% had an LDL-C <70 mg/dL, ranging 35.8% to 49.4% across systems. There was no association between the odds of achieving LDL-C <70 mg/dL and health system lipid management algorithm, prevention clinics/lipid clinics, or electronic health record-based tools. Neither system-level high-intensity statin utilization nor nonstatin use was associated with an LDL-C <70 mg/dL.

CONCLUSIONS

Despite variability in lipid management resources and lipid-lowering therapy use across systems, many did not reach an LDL-C <70 mg/dL, and there was low uptake of lipid-lowering therapy. Innovative implementation strategies are needed for system-level lipid management.

MeSH

Cardiovascular Diseases, Blood Pressure, Algorithms, Electronic Health Records, Records, Therapeutics, Hydroxymethylglutaryl-Coa Reductase Inhibitors