Guideline Concordance of Statin Treatment Decisions: A Retrospective Cohort Study

Journal of Clinical Medicine

Yael Rachamin¹  Thomas Grischott¹  Stefan Markun¹  Rahel Meier¹  Thomas Rosemann¹ 

[1] Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistr. 24, 8091 Zurich, Switzerland;

关键词: guideline adherence;    statins;    cardiovascular diseases;    low-density lipoprotein cholesterol;    prevention;   

DOI  :  10.3390/jcm9113719

来源: DOAJ

【 摘 要 】

Guidelines recommend initiation of statins depending on cardiovascular risk and low-density lipoprotein cholesterol (LDL-C) levels. In this retrospective cohort study, we aimed to assess guideline concordance of statin treatment decisions and to find determinants of undertreatment in Swiss primary care in the period 2016–2019. We drew on electronic medical records of 8060 statin-naive patients (50.0% female, median age 59 years) with available LDL-C levels and cardiovascular risk. Guideline concordance was assessed based on the recommendations of the European Society of Cardiology, and multilevel logistic regression was performed to find determinants of undertreatment. We found that statin treatment was initiated in 10.2% of patients (50.0% female, median age 59 years) during one year of follow up. Treatment decisions were classified as guideline-concordant in 63.0%, as undertreatment in 35.8% and as overtreatment in 1.2%. Among determinants of undertreatment were small deviation from LDL-C treatment thresholds (odds ratio per decrease by 1 mmol/L: 2.09 [95% confidence interval 1.87–2.35]), high compared with very high cardiovascular risk (1.64 [1.30–2.05]), female sex (1.31 [1.05–1.64]), and being treated by older general practitioners (per 10 year decrease: 0.74 [0.61–0.90]). In conclusion, undertreatment of patients at high or very high cardiovascular risk was common, but general practitioners considered cardiovascular risk and LDL-C in their treatment decisions.

【 授权许可】

Unknown