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Low Statin Use Despite Expanded Guidelines

Core Concepts
Statin usage remains low despite expanded guidelines for at-risk patients.
TOPLINE: Study in Annals of Internal Medicine on statin use post-2013 guidelines. METHODOLOGY: Statins lower cholesterol, reduce heart disease risk. ACC/AHA expanded statin prescription criteria in 2013. Research on statin trends from 1999-2018 for 21,961 adults without ASCVD. TAKEAWAY: Statin use peaked at 35% in 2013 despite guideline changes. No increase in statin use for newly eligible adults. Statin use for diabetes patients peaked in 2014. ASCVD risk >20% saw increased statin use till 2013, then plateaued. IN PRACTICE: ACC/AHA guidelines complex, hindered by time constraints. Electronic tools for ASCVD risk calculation underutilized. SOURCE: Led by Timothy S. Anderson, funded by NIH. LIMITATIONS: Lack of data on prior statin offers and risk scores. DISCLOSURES: Authors report no disclosures. AUTHOR: Brittany Vargas, healthcare journalist.
Statin usage peaked at 35% in 2013. Statin use for diabetes patients increased by 31.1 percentage points between 1999 and 2014. Statin use among those with ASCVD risk of more than 20% increased by 23.1 percentage points between 1999 and 2013.
"Although the ACC/AHA guidelines expanded indications for primary prevention, they also increased decision-making complexity, requiring new multistep risk calculation…Many clinicians do not routinely use cardiovascular risk calculators because of a lack of time, input availability, or buy-in."

Key Insights Distilled From

by Brittany Var... at 12-04-2023
Statin Use Remains Low for At-Risk Patients

Deeper Inquiries

How can healthcare systems streamline statin prescription processes to improve adherence?

To improve adherence to statin prescriptions, healthcare systems can implement several strategies. Firstly, incorporating electronic health record tools that calculate ASCVD risks can streamline the decision-making process for clinicians. These tools can help identify at-risk patients who would benefit from statin therapy based on the guidelines. Additionally, providing clinicians with training on the updated guidelines and risk calculation methods can enhance their understanding and confidence in prescribing statins. Moreover, creating standardized protocols and reminders within electronic health records can prompt clinicians to consider statin therapy during patient visits, increasing the likelihood of prescription. Lastly, offering patient education and support programs can help individuals understand the importance of statin therapy and improve their adherence to the prescribed treatment regimen.

What are the potential drawbacks of widespread statin use despite low patient uptake?

Despite the benefits of statin therapy in reducing the risk of ASCVD, there are potential drawbacks to widespread statin use, especially in the context of low patient uptake. One significant concern is the potential for overprescription of statins to individuals who may not derive significant benefits from the medication. This can lead to unnecessary healthcare costs, increased risk of adverse effects, and potential medication non-adherence due to perceived lack of benefit. Additionally, widespread statin use without proper patient education and monitoring can result in suboptimal treatment outcomes and missed opportunities for personalized care. Moreover, the stigma associated with statins and concerns about side effects may deter patients from initiating or continuing treatment, further impacting the effectiveness of widespread statin use.

How can technology better support clinicians in implementing complex guidelines like those for statin use?

Technology can play a crucial role in supporting clinicians in implementing complex guidelines for statin use. One way is through the development and integration of decision support tools within electronic health records that can automatically calculate ASCVD risks and provide personalized treatment recommendations based on the guidelines. These tools can help streamline the decision-making process, reduce cognitive burden on clinicians, and ensure adherence to evidence-based practices. Additionally, telehealth platforms and mobile applications can facilitate remote monitoring of patients on statin therapy, enabling timely adjustments to treatment plans and improving patient engagement. Furthermore, artificial intelligence algorithms can analyze large datasets to identify high-risk individuals who may benefit from statin therapy, assisting clinicians in targeting interventions more effectively. By leveraging technology in these ways, clinicians can enhance the implementation of complex guidelines and improve patient outcomes in statin therapy.