BACKGROUND: The ACC/AHA cholesterol guidelines recommend patients with peripheral artery disease (PAD) be treated with a moderate to high-intensity statin. The extent to which patients with new or worsening PAD symptoms are offered guideline therapy is unknown. HYPOTHESIS: There is significant variability in rate of guideline-directed statin intensification across clinical practices. METHODS: In the PORTRAIT registry, patterns of statin therapy were assessed in 1144 patients at 16 PAD specialty clinics between June 2011 and December 2015 before and after an evaluation for new or worsening claudication symptoms. We documented whether patients were treated with a guideline statin as well as the incidence of statin intensification. Statin intensification was defined as transitioning from no statin or low-intensity statin to moderate or high-intensity statin treatment. Patient factors associated with intensification were examined. Site and provider-level variation in intensification was summarized using an adjusted median odds ratio (aMOR). RESULTS: Among 1144 patients, 810 (70.8%) were initially on guideline therapy compared to 334 (29.2%) that were not. In the latter, 103 (30.8%) received intensification following evaluation. Patients with typical symptoms displayed greater odds of intensification (OR 3.74; 95% CI: 1.23-11.41) while older patients had lower odds of intensification (OR 0.60/decade; 95% CI: 0.41-0.88). Site variability for statin intensification was observed across sites (aMOR = 3.15; 95% CI 1.22-9.60, [P = 0.02]) but not providers (aMOR = 1.89; 95% CI 1.00-3.90, [P = 0.14]). CONCLUSIONS: Most patients evaluated at a PAD specialty clinic for new or worsening claudication symptoms arrived on guideline statin therapy. Only 31% not receiving appropriate therapy underwent statin intensification. These findings highlight an important opportunity to optimize medical therapy for patients with PAD.
BACKGROUND: The ACC/AHA cholesterol guidelines recommend patients with peripheral artery disease (PAD) be treated with a moderate to high-intensity statin. The extent to which patients with new or worsening PAD symptoms are offered guideline therapy is unknown. HYPOTHESIS: There is significant variability in rate of guideline-directed statin intensification across clinical practices. METHODS: In the PORTRAIT registry, patterns of statin therapy were assessed in 1144 patients at 16 PAD specialty clinics between June 2011 and December 2015 before and after an evaluation for new or worsening claudication symptoms. We documented whether patients were treated with a guideline statin as well as the incidence of statin intensification. Statin intensification was defined as transitioning from no statin or low-intensity statin to moderate or high-intensity statin treatment. Patient factors associated with intensification were examined. Site and provider-level variation in intensification was summarized using an adjusted median odds ratio (aMOR). RESULTS: Among 1144 patients, 810 (70.8%) were initially on guideline therapy compared to 334 (29.2%) that were not. In the latter, 103 (30.8%) received intensification following evaluation. Patients with typical symptoms displayed greater odds of intensification (OR 3.74; 95% CI: 1.23-11.41) while older patients had lower odds of intensification (OR 0.60/decade; 95% CI: 0.41-0.88). Site variability for statin intensification was observed across sites (aMOR = 3.15; 95% CI 1.22-9.60, [P = 0.02]) but not providers (aMOR = 1.89; 95% CI 1.00-3.90, [P = 0.14]). CONCLUSIONS: Most patients evaluated at a PAD specialty clinic for new or worsening claudication symptoms arrived on guideline statin therapy. Only 31% not receiving appropriate therapy underwent statin intensification. These findings highlight an important opportunity to optimize medical therapy for patients with PAD.
Authors: Sumeet Subherwal; Manesh R Patel; Lars Kober; Eric D Peterson; William S Jones; Gunnar H Gislason; Jeffrey Berger; Christian Torp-Pedersen; Emil L Fosbol Journal: Circulation Date: 2012-08-08 Impact factor: 29.690
Authors: Amer K Ardati; Samuel R Kaufman; Herbert D Aronow; Timothy J Nypaver; Paul G Bove; Hitinder S Gurm; P Michael Grossman Journal: Circ Cardiovasc Interv Date: 2012-12-11 Impact factor: 6.546
Authors: Salim S Virani; Yashashwi Pokharel; Lynne Steinberg; Winston Chan; Julia M Akeroyd; Saqib Ali Gowani; Ankur Kalra; Venkateshwar Polsani; Michael D Miedema; Peter H Jones; Vijay Nambi; Laura A Petersen; Christie M Ballantyne Journal: J Clin Lipidol Date: 2015-11-17 Impact factor: 4.766
Authors: S Marlene Grenon; Eric Vittinghoff; Christopher D Owens; Michael S Conte; Mary Whooley; Beth E Cohen Journal: Vasc Med Date: 2013-07-08 Impact factor: 3.239
Authors: Gregory G Westin; Ehrin J Armstrong; Heejung Bang; Khung-Keong Yeo; David Anderson; David L Dawson; William C Pevec; Ezra A Amsterdam; John R Laird Journal: J Am Coll Cardiol Date: 2013-12-04 Impact factor: 24.094
Authors: M M McDermott; P Greenland; K Liu; J M Guralnik; M H Criqui; N C Dolan; C Chan; L Celic; W H Pearce; J R Schneider; L Sharma; E Clark; D Gibson; G J Martin Journal: JAMA Date: 2001-10-03 Impact factor: 56.272
Authors: Yevgeniy Khariton; Krishna K Patel; Paul S Chan; Yashashwi Pokharel; Jingyan Wang; John A Spertus; David M Safley; William R Hiatt; Kim G Smolderen Journal: Clin Cardiol Date: 2018-10-19 Impact factor: 2.882
Authors: Yevgeniy Khariton; Krishna K Patel; Paul S Chan; Yashashwi Pokharel; Jingyan Wang; John A Spertus; David M Safley; William R Hiatt; Kim G Smolderen Journal: Clin Cardiol Date: 2018-10-19 Impact factor: 2.882