Key result
Post-PCI high-intensity statin use rose ~3.5-fold among veterans between 2010 and 2016.
Why the study?
Full implementation of the 2013 ACC/AHA blood cholesterol guideline recommendation for high-intensity statin therapy had not been satisfactory, prompting evaluation of temporal trends and predictors of high-intensity statin use among veterans after PCI.
Did the implementation of the 2013 ACC/AHA blood cholesterol guideline increase the rate of high-intensity statin prescription within 90 days post-PCI among US veterans?
Cohort (n=48,862)
Yes
Did the implementation of the 2013 ACC/AHA blood cholesterol guideline increase the rate of high-intensity statin prescription within 90 days post-PCI among US veterans?
Answers are grounded in this paper and cite their sources.
Demonstrates rapid and high-level implementation (reaching 80% by 2016) of the 2013 ACC/AHA high-intensity statin guideline among post-PCI patients in the Veterans Health Administration, despite conflicting VA/DoD guidance recommending moderate-intensity statins.
BACKGROUND: The 2013 American College of Cardiology/American Heart Association blood cholesterol guideline recommends high-intensity statin therapy among certain groups of patients, but full implementation of the guideline has not yet been satisfactory. We aimed to investigate the temporal trends and predictors of high-intensity statin therapy among veterans who had been treated with percutaneous coronary intervention (PCI) and followed up by cardiologists within the Veterans Health Administrative system. METHODS AND RESULTS: A retrospective cohort study was conducted at the Veterans Health Administrative system including all patients >18 years old who had their PCI procedure between October 2010 and September 2016. National Veterans Health Administrative databases were used to retrieve study participant's demographics, comorbid conditions, statin type and dose within 90 days before and after the PCI procedure. There were 48 862 patients who underwent a PCI procedure during the study period. High-intensity statin use at 90 days post-PCI rose from 23% in 2010 to 37% before release of the 2013 American College of Cardiology/American Heart Association cholesterol guideline, then rose sharply to 80% by 2016. The projected 10-year risk of arteriosclerotic cardiovascular disease events among our study population was projected to be ≈1841 fewer if the cohort had received high-intensity statin therapy versus moderate-intensity statin. CONCLUSIONS: By 2016, the 2013 American College of Cardiology/American Heart Association blood cholesterol guideline was well implemented among veterans who had a PCI procedure in the Veterans Health Administrative system, suggesting systems of care can be improved to increase rates of high-intensity statin initiation.
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Abdulhak et al. (2018) conducted a cohort in Coronary artery disease treated with percutaneous coronary intervention (n=48,862). PCI in Fiscal Year 2016 (post-2013 ACC/AHA cholesterol guideline era) vs. PCI in Fiscal Year 2010 (pre-guideline reference year) was evaluated on Receipt of high-intensity statin therapy within 90 days post-PCI (atorvastatin 40-80 mg or rosuvastatin 20-40 mg) (RR 3.54, 95% CI 3.46-3.62). High-intensity statin use at 90 days post-PCI among veterans rose from 23% in 2010 to 80% by 2016 (RR 3.54, 95% CI 3.46-3.62), projected to prevent ~1,841 ASCVD events over 10 years.
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