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Statin initiations and QRISK2 scoring in UK general practice: a THIN database study
Samuel Finnikin1, Ronan Ryan1, Tom Marshall1
1Institute of Applied Health Research, University of Birmingham, Birmingham.
Summary
Most high-risk patients do not receive statins, while low-risk patients are overtreated. Updated guidelines in 2014 saw statin use decrease in high-risk groups but increase in intermediate-risk groups, indicating ongoing issues with cardiovascular disease prevention.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Statin prescribing for cardiovascular disease (CVD) prevention should align with patient risk, yet evidence indicates both undertreatment in high-risk individuals and overtreatment in low-risk populations.
- This study addresses the gap in understanding statin prescription patterns relative to calculated CVD risk in primary care.
Purpose of the Study:
- To examine the association between cardiovascular disease (CVD) risk scoring in primary care and the initiation of statin therapy for primary CVD prevention.
- To evaluate the impact of revised National Institute for Health and Care Excellence (NICE) guidelines in 2014 on statin prescribing practices.
Main Methods:
- A historical cohort study was conducted using UK electronic primary care records.
- Data included statin-naïve patients without diagnosed CVD from 2000 to 2015.
- Cardiovascular disease (CVD) risk scores (QRISK2, available from 2012) and statin initiation events were analyzed in relation to risk categories (<10%, 10-19.9%, ≥20% 10-year risk).
Main Results:
- Out of 1.4 million patients, only 10.67% had a recorded CVD risk score since 2012.
- Among patients receiving statins after 2012, only 27.1% had a documented QRISK2 score.
- Statin initiation occurred in 2.7% of low-risk, 13.8% of intermediate-risk, and 35.0% of high-risk patients. Statin initiation rates declined significantly after 2006 and post-2014 NICE guideline changes, particularly in high-risk groups.
Conclusions:
- The majority of statin initiations lacked a recorded QRISK2 risk score, highlighting a significant data recording issue.
- A substantial proportion of high-risk patients were not prescribed statins, indicating undertreatment.
- Approximately 16.7% of statin initiations were for low-risk patients, signifying overtreatment. Statin initiation increased in intermediate-risk patients following the 2014 NICE guideline update.
Keywords:
clinical guidancegeneral practicehydroxymethylglutaryl-CoA reductase inhibitorsprimary preventionrisk assessmentstatinsMore Related Videos
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