Uptake of Statin Use for Prevention of Cardiovascular Disease Guideline Using Electronic Health Record Patient Data from 2013-2016
| Category | Baseline | 1 Year After | 2 Years After | P-Value |
|---|---|---|---|---|
| Overall guideline uptake | ||||
| Overall uptake of 2013 ACC/AHA guideline | 18,690 (18.5%) | 20,408 (19.0%) | 21,719 (20.3%) | < .01 |
| Highest-risk patients—CVD | ||||
| Age 40 to 75 years with CVD on high-dose statin | 1435 (16.4%) | 1764 (18.1%) | 2227 (20.5%) | < .01 |
| Age 40 to 75 years with CVD on any statin | 4592 (52.5%) | 5101 (52.4%) | 5757 (52.9%) | .73 |
| Moderate-risk patients—heredity hyperlipidemia or diabetes (risk ≥7.5%) or primary prevention (risk ≥ 10%) | ||||
| Age 40 to 75 years with LDL ≥ 190 on high-dose statin | 124 (10.8%) | 160 (12.7%) | 158 (12.8%) | .26 |
| Age 40 to 75 years with LDL ≥ 190 on any statin | 592 (51.8%) | 638 (50.6%) | 626 (50.9%) | .85 |
| Age 40 to 75 years with DM and ≥ 7.5% risk on high-dose statin | 904 (12.2%) | 1124 (13.8%) | 1353 (15.1%) | < .01 |
| Age 40 to 75 years with DM and ≥ 7.5% risk on any statin | 4044 (54.7%) | 4513 (55.3%) | 5067 (56.6%) | .05 |
| Age 40 to 75 years with > 10% risk on moderate- or high-dose statin | 6046 (43.0%) | 6704 (43.6%) | 7541 (45.6%) | < .01 |
| Age 40 to 75 years with > 10% risk on any statin | 6733 (47.9%) | 7413 (48.2%) | 8216 (49.6%) | < .01 |
| Lower-risk patients—diabetes or primary prevention and risk <7.5% | ||||
| Age 40 to 75 years with DM and < 7.5% risk on moderate- or high-dose statin | 2879 (40.8%) | 3323 (43.3%) | 3647 (44.9%) | < .01 |
| Age 40 to 75 years with DM and < 7.5% risk on any statin | 3192 (45.2%) | 3664 (47.7%) | 3957 (48.7%) | < .01 |
| Age 40 to 75 years with 7.5 to 10% risk on moderate- or high-dose statin | 1211 (37.9%) | 1315 (37.9%) | 1363 (37.7%) | .99 |
| Age 40 to 75 years with 7.5 to 10% CVD risk on any statin | 1325 (41.5%) | 1441 (41.5%) | 1504 (41.6%) | .99 |
| Patients receiving non-recommended care or potential overuse | ||||
| Age 40 to 75 years on non-statin medication | 10,454 (10.7%) | 11,282 (10.9%) | 11,642 (11.3%) | < .01 |
| Age 40 to 75 years on 80-mg simvastatin* | 541 (0.6%) | 460 (0.4%) | 455 (0.4%) | < .01 |
| Any age on a statin without an indication | 1867 (7.0%) | 1919 (6.6%) | 1890 (6.2%) | < .01 |
| Age 40 to 75 years with lipid measurement in past 15 months | 61,350 (62.8%) | 66,468 (64.2%) | 67,974 (65.9%) | < .01 |
ACC, American College of Cardiology; AHA, American Heart Association; CVD, cardiovascular disease; DM, diabetes mellitus; LDL, low-density lipoprotein.
Italic value denotes statistically significant increase in guideline uptake compared with baseline and adjusted for clinician and practice (included as random effects).
Bold italic value denotes statistically significant decrease in guidelines uptake compared with baseline and adjusted for clinician and practice (included as random effects).
↵* Current FDA black box warning recommends against using simvastatin at 80-mg dosing.