Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.
Am J Cardiol. 2019 Oct 15;124(8):1165-1170. doi: 10.1016/j.amjcard.2019.07.022. Epub 2019 Jul 25.
Statin use remains suboptimal in patients with atherosclerotic cardiovascular disease (ASCVD). We assessed whether outpatient care with a cardiology provider is associated with evidence-based statin prescription and statin adherence. We identified patients with ASCVD aged ≥18 years receiving primary care in 130 facilities and associated community-based outpatient clinics in the entire Veterans Affairs Health Care System between October 1, 2013 and September 30, 2014. Patients were divided into: (1) patients with at least 1 outpatient cardiology visit and (2) patients with no outpatient cardiology visits in the year before the index primary care visit. We assessed any- and high-intensity statin prescription adjusting for several patient- and facility-level covariates, and statin adherence using proportion of days covered (PDC). We included 1,249,061 patients with ASCVD (mean age: 71.9 years; 98.0% male). After adjusting for covariates, patients who visited a cardiology provider had greater odds of being on a statin (87.4% vs 78.4%; Odds ratio [OR] 1.25, 95% Confidence interval [CI] 1.24 to 1.26), high-intensity statin (34.5% vs 21.2%; OR: 1.21, 95% CI 1.21 to 1.22), and higher statin adherence (mean PDC 0.76 ± 0.29 vs 0.70 ± 0.34, PDC ≥0.8: 62.0% vs 57.3%; OR 1.09, 95% CI 1.09 to 1.11). A dose response relation was seen with a higher number of cardiology visits associated with a higher statin use and statin adherence. In conclusion, compared with outpatient care delivered by primary care providers alone, care delivered by a cardiology provider for patients with ASCVD is associated with a higher likelihood of guideline-based statin use and statin adherence.
他汀类药物在动脉粥样硬化性心血管疾病（ASCVD）患者中的应用仍不理想。我们评估了心血管病医生的门诊治疗是否与基于证据的他汀类药物处方和他汀类药物依从性有关。我们确定了 2013 年 10 月 1 日至 2014 年 9 月 30 日期间，在整个退伍军人事务部医疗保健系统中，130 个医疗设施和相关的社区门诊接受初级保健的年龄≥18 岁的 ASCVD 患者。患者分为：（1）至少有 1 次门诊心血管病就诊的患者；（2）在指数初级保健就诊前一年无门诊心血管病就诊的患者。我们评估了任何强度和高强度他汀类药物的处方调整了几个患者和设施水平的混杂因素，并使用覆盖天数（PDC）来评估他汀类药物的依从性。我们纳入了 1249061 例 ASCVD 患者（平均年龄：71.9 岁；98.0%为男性）。在调整了混杂因素后，看心血管病医生的患者使用他汀类药物的可能性更高（87.4% vs 78.4%；比值比[OR] 1.25，95%置信区间[CI] 1.24 至 1.26）、高强度他汀类药物（34.5% vs 21.2%；OR：1.21，95% CI 1.21 至 1.22）和更高的他汀类药物依从性（平均 PDC 0.76 ± 0.29 vs 0.70 ± 0.34，PDC≥0.8：62.0% vs 57.3%；OR 1.09，95% CI 1.09 至 1.11）。随着看心血管病医生次数的增加，与更高的他汀类药物使用率和他汀类药物依从性呈剂量反应关系。总之，与单纯由初级保健提供者提供的门诊治疗相比，为 ASCVD 患者提供的心血管病医生的治疗与更高的基于指南的他汀类药物使用率和他汀类药物依从性相关。
