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Low use of statins for secondary prevention in primary care: a survey in a northern Swedish population
BACKGROUND: Cholesterol-lowering therapy with statins is recommended in established cardiovascular disease (CVD) and should be considered for patients at high cardiovascular risk. We surveyed statin treatment before first-time myocardial infarction in clinical practice compared to current guidelines...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982203/ https://www.ncbi.nlm.nih.gov/pubmed/27515746 http://dx.doi.org/10.1186/s12875-016-0505-0 |
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author | Nilsson, Gunnar Samuelsson, Eva Söderström, Lars Mooe, Thomas |
author_facet | Nilsson, Gunnar Samuelsson, Eva Söderström, Lars Mooe, Thomas |
author_sort | Nilsson, Gunnar |
collection | PubMed |
description | BACKGROUND: Cholesterol-lowering therapy with statins is recommended in established cardiovascular disease (CVD) and should be considered for patients at high cardiovascular risk. We surveyed statin treatment before first-time myocardial infarction in clinical practice compared to current guidelines, in patients with and without known CVD in primary care clinics with general practitioners (GPs) on short-term contracts vs. permanent staff GPs. METHODS: A total of 931 patients (345 women) in northern Sweden were enrolled in the study between November 2009 and December 2014 and stratified by prior CVD, comprising angina pectoris, revascularisation, ischaemic stroke or transitory ischaemic attack, or peripheral artery disease. Primary care clinics were classified by the proportion of GP salaries that were paid to GPs working on short-term contracts: low (0–9 %), medium (10–39 %), or high (≥40 %). We used logistic regression to identify determinants of statin treatment. RESULTS: Among patients with prior CVD, only 34.5 % received statin treatment before myocardial infarction. The probability of statin treatment decreased with age (≥70 years OR 0.30; 95 % CI 0.13–0.66) and female gender (OR 0.39; 95 % CI 0.20–0.78) but increased in patients with diabetes (OR 3.52; 95 % CI 1.75–7.08). Among patients with prior CVD, the type of primary care clinic was not predictive of statin treatment. In the entire study cohort, 17.3 % of patients were treated with statins; women < 70 years old were more likely to receive statin treatment than women ≥70 years old (OR 3.24; 95 % CI 1.64–6.38), and men ≥70 years old were twice as likely to be treated with statins than women of the same age (OR 2.22; 95 % CI 1.31–3.76) after adjusting for diabetes and CVD. Overall, patients from clinics with predominantly permanent staff GPs received statin therapy less frequently than those with GPs on short-term contracts. CONCLUSIONS: In patients with prior CVD we found considerable under-treatment with statins, especially among women and the elderly. Methodologies for case findings, recall, and follow-up need to be improved and implemented to reach the goals for CVD prevention in clinical practice. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12875-016-0505-0) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4982203 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-49822032016-08-13 Low use of statins for secondary prevention in primary care: a survey in a northern Swedish population Nilsson, Gunnar Samuelsson, Eva Söderström, Lars Mooe, Thomas BMC Fam Pract Research Article BACKGROUND: Cholesterol-lowering therapy with statins is recommended in established cardiovascular disease (CVD) and should be considered for patients at high cardiovascular risk. We surveyed statin treatment before first-time myocardial infarction in clinical practice compared to current guidelines, in patients with and without known CVD in primary care clinics with general practitioners (GPs) on short-term contracts vs. permanent staff GPs. METHODS: A total of 931 patients (345 women) in northern Sweden were enrolled in the study between November 2009 and December 2014 and stratified by prior CVD, comprising angina pectoris, revascularisation, ischaemic stroke or transitory ischaemic attack, or peripheral artery disease. Primary care clinics were classified by the proportion of GP salaries that were paid to GPs working on short-term contracts: low (0–9 %), medium (10–39 %), or high (≥40 %). We used logistic regression to identify determinants of statin treatment. RESULTS: Among patients with prior CVD, only 34.5 % received statin treatment before myocardial infarction. The probability of statin treatment decreased with age (≥70 years OR 0.30; 95 % CI 0.13–0.66) and female gender (OR 0.39; 95 % CI 0.20–0.78) but increased in patients with diabetes (OR 3.52; 95 % CI 1.75–7.08). Among patients with prior CVD, the type of primary care clinic was not predictive of statin treatment. In the entire study cohort, 17.3 % of patients were treated with statins; women < 70 years old were more likely to receive statin treatment than women ≥70 years old (OR 3.24; 95 % CI 1.64–6.38), and men ≥70 years old were twice as likely to be treated with statins than women of the same age (OR 2.22; 95 % CI 1.31–3.76) after adjusting for diabetes and CVD. Overall, patients from clinics with predominantly permanent staff GPs received statin therapy less frequently than those with GPs on short-term contracts. CONCLUSIONS: In patients with prior CVD we found considerable under-treatment with statins, especially among women and the elderly. Methodologies for case findings, recall, and follow-up need to be improved and implemented to reach the goals for CVD prevention in clinical practice. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12875-016-0505-0) contains supplementary material, which is available to authorized users. BioMed Central 2016-08-11 /pmc/articles/PMC4982203/ /pubmed/27515746 http://dx.doi.org/10.1186/s12875-016-0505-0 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Nilsson, Gunnar Samuelsson, Eva Söderström, Lars Mooe, Thomas Low use of statins for secondary prevention in primary care: a survey in a northern Swedish population |
title | Low use of statins for secondary prevention in primary care: a survey in a northern Swedish population |
title_full | Low use of statins for secondary prevention in primary care: a survey in a northern Swedish population |
title_fullStr | Low use of statins for secondary prevention in primary care: a survey in a northern Swedish population |
title_full_unstemmed | Low use of statins for secondary prevention in primary care: a survey in a northern Swedish population |
title_short | Low use of statins for secondary prevention in primary care: a survey in a northern Swedish population |
title_sort | low use of statins for secondary prevention in primary care: a survey in a northern swedish population |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982203/ https://www.ncbi.nlm.nih.gov/pubmed/27515746 http://dx.doi.org/10.1186/s12875-016-0505-0 |
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