Treatment Gap in Primary Prevention Patients Presenting With Acute Coronary Syndrome
Aakash Bavishi1, Travis Howard1, Jooho P Kim1
1Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Insights
Many patients experiencing a first acute coronary syndrome (ACS) event were eligible for statin therapy under 2013 cholesterol guidelines but did not receive it. This highlights a gap in primary prevention for cardiovascular disease.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Guidelines
Background:
- Previous research indicates underuse of statin therapy despite 2013 ACC/AHA cholesterol guidelines.
- Limited data exists on guideline adherence for statin use in primary prevention patients.
- Acute coronary syndrome (ACS) represents a critical event in cardiovascular disease progression.
Purpose of the Study:
- To evaluate the impact and adherence to the 2013 ACC/AHA cholesterol guidelines in primary prevention patients.
- To assess statin therapy initiation and intensity in patients presenting with their first ACS event.
Main Methods:
- Retrospective analysis of 1,265 primary prevention patients (ages 40-75) with first-time ACS.
- Calculation of 10-year Atherosclerotic Cardiovascular Disease (10yASCVD) risk.
- Utilized multivariable linear regression to predict systolic blood pressure when not available.
Main Results:
- A significant proportion of patients with a first ACS event met criteria for statin therapy based on 2013 ACC/AHA guidelines prior to their event.
- Statistical significance observed in overall statin status, ST Elevation Myocardial Infarction (STEMI), and left heart catheterization dates.
- Analysis revealed underutilization of statin therapy at appropriate intensities in this primary prevention cohort.
Conclusions:
- Many patients experiencing a first ACS event were undertreated with statins according to 2013 ACC/AHA guidelines.
- This study underscores a critical gap in primary cardiovascular disease prevention and guideline implementation.
- Improved adherence to cholesterol guidelines could potentially reduce ACS events in high-risk primary prevention populations.
Abstract:
Previous studies assessing healthcare provider compliance to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines indicate a significant underuse of statin therapy at appropriate intensity. However, data are limited in primary prevention patients. Our study aimed to evaluate the impact of the 2013 ACC/AHA guidelines through a retrospective analysis of primary prevention patients presenting with first time acute coronary syndrome (ACS). We retrospectively calculated the 10-year predicted Atherosclerotic Cardiovascular Disease (10yASCVD) risk in 1,265 patients ages 40 to 75 who presented with ACS and no previous ASCVD. In patients without known ambulatory systolic blood pressure, a multivariable linear regression model was used to predict outpatient systolic blood pressure. Outcomes analyzed in each 10yASCVD category included statin status and statin intensity (high/medium/low) with further categorization by type of ACS event and date of left heart catheterization. In both primary analysis and sensitivity analysis (patients with predicted systolic blood pressure), statistical significance was shown with respect to overall statin status, ST Elevation Myocardial Infarction, and date of left heart catheterization. In summary, retrospective calculation of 10yASCVD in patients with a first ACS event showed a significant number of ACS patients would have qualified for statin therapy per 2013 ACC/AHA guidelines before their event but had not been initiated on one.
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