Pokharel Yashashwi, Akeroyd Julia M, Ramsey David J, Hira Ravi S, Nambi Vijay, Shah Tina, Woodard LeChauncy D, Winchester David E, Ballantyne Christie M, Petersen Laura A, Virani Salim S
Saint Luke's Mid-America Heart Institute, University of Missouri-Kansas City, Missouri.
Department of Medicine, Baylor College of Medicine, Houston, Texas.
Clin Cardiol. 2016 Apr;39(4):185-91. doi: 10.1002/clc.22503. Epub 2016 Apr 5.
We sought to determine use of any and at least moderate-intensity statin therapy in a national sample of patients with diabetes mellitus (DM), with the hypothesis that nationwide frequency and facility-level variation in statin therapy are suboptimal. We sampled patients with DM age 40 to 75 years receiving primary care between October 1, 2012, and September 30, 2013, at 130 parent facilities and associated community-based outpatient clinics in the Veterans Affairs Health Care System. We examined frequency and facility-level variation in use of any or at least moderate-intensity statin therapy (mean daily dose associated with ≥30% low-density lipoprotein cholesterol lowering). In 911 444 patients with DM, 68.3% and 58.4% were receiving any and moderate- to high-intensity statin therapy, respectively. Patients receiving statin had higher burden of cardiovascular disease, were more likely to be on nonstatin lipid-lowering therapy and to receive care at a teaching facility, and had more frequent primary-care visits. Median facility-level uses of any and at least moderate-intensity statin therapy were 68.7% (interquartile range, 65.9%-70.8%) and 58.6% (interquartile range, 55.8%-61.4%), respectively. After adjusting for several patient-related and some facility-related characteristics, the median rate ratios for any and moderate- to high-intensity statin therapy were 1.20 (95% confidence interval: 1.18-1.22) and 1.29 (95% confidence interval: 1.24-1.33) respectively, indicating 20% to 29% variation in statin use between 2 identical patients receiving care at 2 random facilities. Statin use was suboptimal in a national sample of patients with DM with modest facility-level variation, likely indicating differences in statin-prescribing patterns.
我们试图在全国糖尿病（DM）患者样本中确定任何他汀类药物治疗以及至少中等强度他汀类药物治疗的使用情况，假设他汀类药物治疗的全国频率和机构水平差异并不理想。我们对2012年10月1日至2013年9月30日期间在退伍军人事务医疗保健系统的130家主要机构及相关社区门诊接受初级保健的40至75岁糖尿病患者进行了抽样。我们研究了任何或至少中等强度他汀类药物治疗（与低密度脂蛋白胆固醇降低≥30%相关的平均日剂量）的使用频率和机构水平差异。在911444例糖尿病患者中，分别有68.3%和58.4%接受了任何他汀类药物治疗和中等至高强度他汀类药物治疗。接受他汀类药物治疗的患者心血管疾病负担更高，更有可能接受非他汀类降脂治疗并在教学机构接受治疗，且初级保健就诊更频繁。机构水平上任何他汀类药物治疗和至少中等强度他汀类药物治疗的中位数使用比例分别为68.7%（四分位间距，65.9%-70.8%）和58.6%（四分位间距，55.8%-61.4%）。在调整了几个患者相关和一些机构相关特征后，任何他汀类药物治疗和中等至高强度他汀类药物治疗的中位数率比分别为1.20（95%置信区间：1.18-1.22）和1.29（95%置信区间：1.24-1.33），表明在两家随机机构接受治疗的两名相同患者之间，他汀类药物使用存在20%至29%的差异。在全国糖尿病患者样本中，他汀类药物使用并不理想，机构水平差异不大，这可能表明他汀类药物处方模式存在差异。
