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.
Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Cardiovasc Drugs Ther. 2022 Feb;36(1):93-102. doi: 10.1007/s10557-020-07125-3. Epub 2021 Jan 5.
We investigated facility-level variation in the use and adherence with antiplatelets and statins among patients with premature and extremely premature ASCVD.
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.
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.
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.
我们研究了在患有早发和极早发 ASCVD 的患者中，医疗机构层面抗血小板和他汀类药物的使用和依从性差异。
我们使用 2014-2015 年全国退伍军人早发动脉粥样硬化（VITAL）登记处，评估了早发（首次 ASCVD 事件时年龄：男性 <55 岁，女性 <65 岁）和极早发 ASCVD（<40 岁）患者。我们检查了在 130 家全国退伍军人事务部医疗保健机构中，任意他汀类药物、高强度他汀类药物（HIS）、抗血小板药物（阿司匹林、氯吡格雷、替格瑞洛、普拉格雷和噻氯匹定）的使用频率和医疗机构层面差异，以及他汀类药物的依从性（覆盖比例≥0.8）。使用中位数率比（MRR）来计算医疗机构层面的差异，这是衡量两个随机医疗机构在使用他汀类药物或抗血小板药物和他汀类药物依从性方面差异的可能性的指标。
我们的分析包括了 135703 名早发 ASCVD 患者和 7716 名极早发 ASCVD 患者。在所有医疗机构中，早发 ASCVD 患者的任意他汀类药物治疗、HIS 治疗和抗血小板药物治疗的中位（IQR）处方率分别为 0.73（0.70-0.75）、0.36（0.32-0.41）和 0.77（0.73-0.81）。任意他汀类药物使用、HIS 使用和抗血小板药物使用的 MRR（95%CI）分别为 1.53（1.44-1.60）、1.58（1.49-1.66）和 1.49（1.42-1.56），分别显示了 53%、58%和 49%的医疗机构层面差异。他汀类药物依从性的中位（IQR）医疗机构水平率为 0.58（0.55-0.62），他汀类药物依从性的 MRR 为 1.13（1.10-1.15），显示了 13%的医疗机构层面差异。在极早发 ASCVD 患者中也观察到了类似的中位医疗机构水平率和差异。
在早发和极早发 ASCVD 患者中，他汀类药物和抗血小板药物的使用存在不理想和显著的医疗机构层面差异。需要采取干预措施来优化年轻 ASCVD 患者的治疗并减少差异。
