Abstract 12446: Frequency and Practice Level Variation in Statin Use Among Patients With Diabetes: Insights From the NCDR® PINNACLE Registry
Background: Statins reduce major adverse cardiovascular events and mortality among patients with diabetes and routine use is endorsed by clinical practice guidelines. However, national trends and practice level variation in statin use are not known.
Methods: From the American College of Cardiology’s Practice Innovation and Clinical Excellence (PINNACLE) registry, we identified 256,701 patients with diabetes 40-75 years of age from 187 practices with at least 30 diabetic patients between May 1, 2008 and September 31, 2014. Among patients without contraindication to statin therapy, we calculated the percentage of patients receiving statin therapy at each practice. We then examined variation in statin use across practices using multivariable hierarchical regression to determine median rate ratio (MRR), which quantifies the likelihood that 2 randomly chosen practices would differ in treating an identical patient.
Results: Overall, 141,900 (55%) diabetic patients were on statins. Those prescribed statins were more likely to be men, of white race, have coexisting dyslipidemia or hypertension, be on non-statin lipid lowering medications and have lower LDL-C levels (91 vs. 103 mg/dL, P<0.001 for all). The median practice level use of statin was 57% (IQR, 48-63%), which remained similar throughout the study period. The adjusted MRR for statin use was 1.62 (95% CI: 1.57-1.67), indicating 62% differences in likelihood of statin treatment between 2 identical patients at 2 random practices (Figure).
Conclusion: In a national outpatient registry, just over half of patients with diabetes 40-75 years old were treated with statins, with wide variation across cardiology practices. These results suggest that quality improvement initiatives are needed to support guideline recommended use of statins among patients with diabetes.
Author Disclosures: Y. Pokharel: Research Grant; Modest; Supported by the 2015-2016 American Medical Association Foundation Seed Grant Award. Research Grant; Significant; Supported by the American Heart Association SWA Summer 2014 Postdoctoral Fellowship Award, 15POST23080014. K. Gosch: None. A. Grodzinsky: Research Grant; Significant; Supported by a T32 training grant from the NHLBI (#HL110837). V. Nambi: Research Grant; Significant; Merck. Consultant/Advisory Board; Significant; Sanofi Regeneron. Other; Significant; Provisional patent (# 61721475) entitled “Biomarkers to Improve Prediction of Heart Failure Risk” filed by Baylor College of Medicine, Roche. P. Chan: Research Grant; Significant; National Institutes of Health. Other; Significant; OptumRx. M. Kosiborod: Research Grant; Significant; American Heart Association, Gilead Sciences, Genentech, Sanofi-Aventis, Eisai. Consultant/Advisory Board; Modest; Eli Lilly, Regeneron, Takeda, Edwards Lifesciences, Gilead Sciences, Roche. Consultant/Advisory Board; Significant; AstraZeneca, Amgen. J. Spertus: Other; Significant; Research Contract from ACC for PINNACLE analyses. C. Ballantyne: Research Grant; Significant; (All paid to institution, not individual)- Abbott Diagnostic, Amarin, Amgen, Eli Lilly, Esperion, Novartis, Pfizer, Otsuka, Regeneron, 19 Roche Diagnostic, Sanofi-Synthelabo, Takeda, National Institut. Consultant/Advisory Board; Significant; Abbott Diagnostics, Amarin, Amgen, Astra Zeneca, Eli Lilly, Esperion, Genzyme, Matinas BioPharma Inc, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi- Synthelabo.. Other; Significant; Provisional patent (# 61721475) entitled “Biomarkers to Improve Prediction of Heart Failure Risk” filed by Baylor College of Medicine, Roche.. L. Petersen: None. S. Virani: Research Grant; Significant; American Diabetes Association Clinical Science and Epidemiology Award, American Heart Association Beginning Grant-in-Aid, Baylor College of Medicine Center for Globalization Grant. Other; Significant; Serves on the steering committee (no financial remuneration) for the Patient and Provider Assessment of Lipid Management (PALM) Registry at the Duke Clinical Research Institute.
- © 2015 by American Heart Association, Inc.