Dhruv Mahtta1,2, Michelle T Lee1,2, David J Ramsey1, Julia M Akeroyd1, Chayakrit Krittanawong2, Safi U Khan3, Preetika Sinh4, Mahboob Alam2, Kirk N Garratt5, Richard S Schofield6, Christie M Ballantyne2,7, Laura A Petersen1, Salim S Virani8,9,10,11. 1. Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, 2002 Holcombe Blvd, Houston, TX, 77030, USA. 2. Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. 3. Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA. 4. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA. 5. Center for Heart and Vascular Health, ChristianaCare, Newark, DE, USA. 6. Division of Cardiovascular Medicine, University of Florida, Gainesville, FL and Department of Veterans Affairs Medical Center, Gainesville, FL, USA. 7. Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. 8. Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, 2002 Holcombe Blvd, Houston, TX, 77030, USA. virani@bcm.edu. 9. Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. virani@bcm.edu. 10. Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. virani@bcm.edu. 11. Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. virani@bcm.edu.
Abstract
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.
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.
Authors: Dhruv Mahtta; David J Ramsey; Mahmoud Al Rifai; Khurram Nasir; Zainab Samad; David Aguilar; Hani Jneid; Christie M Ballantyne; Laura A Petersen; Salim S Virani Journal: JAMA Netw Open Date: 2020-08-03