Factors predicting statin prescribing for primary prevention: a historical cohort study.
Factors predicting statin prescribing for primary prevention: a historical cohort study.
复制标题
DOI：
10.3399/bjgp20x714065
复制
发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Marshall T
中科院分区：
文献类型：
--
作者：
Finnikin S;Willis BH;Ryan R;Evans T;Marshall T
他汀类药物用于心血管疾病(CVD)的一级预防应该基于心血管疾病风险估计，但它们的使用是次优的。目的：探讨临床医生编码和不编码估计心血管疾病风险(QRISK2)时他汀类药物处方的影响因素。在英国初级保健记录的数据库(IQVIA医学研究数据)中进行血脂测试的患者的历史队列。队列包括2012至2016年间的686560项(血脂测试结果)，来自383 416名没有心血管疾病史的他汀类药物初治患者。提取编码的QRISK2分数，变量用于计算QRISK2和可能影响他汀类药物处方的因素。如果QRISK2分数没有编码，它是在特殊情况下计算的。结果是在血脂测试结果的60天内开始服用他汀类药物。在这些条目中，146 693个(21.4%)具有编码的QRISK2分数。在编码的QRISK2(P<；0.001)和未编码的QRISK2(P<；0.001)中，6.6%(95%可信区间=6.4%~6.7%)和4.1%(95%CI=4.0%~4.1%)启动了他汀类药物。在85.0%(95%CI=84.2%至85.8%)的编码组和44.2%(95%CI=43.5%至44.9%)的未编码QRISK2组(P<；0.001)中，他汀类药物的启动与国家健康与护理卓越研究所的指南建议一致。当QRISK2分数被编码时，QRISK2分数是他汀类药物启动的主要预测因子，但当QRISK2分数未编码时，总胆固醇是主要预测因子。当QRISK2评分被编码时，处方更符合指南。在没有QRISK2评分的情况下，处方主要基于总胆固醇。使用QRISK2与开他汀类药物有关，这更有可能使患者受益。促进常规的心血管疾病风险评估是优化决策的关键。
Initiation of statins for the primary prevention of cardiovascular disease (CVD) should be based on CVD risk estimates, but their use is suboptimal. To investigate the factors influencing statin prescribing when clinicians code and do not code estimated CVD risk (QRISK2). A historical cohort of patients who had lipid tests in a database (IQVIA Medical Research Data) of UK primary care records. The cohort comprised 686 560 entries (lipid test results) between 2012 and 2016 from 383 416 statin-naive patients without previous CVD. Coded QRISK2 scores were extracted, with variables used in calculating QRISK2 and factors that might influence statin prescribing. If a QRISK2 score was not coded, it was calculated post hoc. The outcome was initiation of a statin within 60 days of the lipid test result. Of the entries, 146 693 (21.4%) had a coded QRISK2 score. Statins were initiated in 6.6% (95% confidence interval [CI] = 6.4% to 6.7%) of those with coded and 4.1% (95% CI = 4.0% to 4.1%) of uncoded QRISK2 (P<0.001). Statin initiations were consistent with National Institute for Health and Care Excellence guideline recommendations in 85.0% (95% CI = 84.2% to 85.8%) of coded and 44.2% (95% CI = 43.5% to 44.9%) of uncoded QRISK2 groups (P<0.001). When coded, QRISK2 score was the main predictor of statin initiation, but total cholesterol was the main predictor when a QRISK2 score was not coded. When a QRISK2 score is coded, prescribing is more consistent with guidelines. With no QRISK2 score, prescribing is mainly based on total cholesterol. Using QRISK2 is associated with statin prescribing that is more likely to benefit patients. Promoting the routine CVD risk estimation is essential to optimise decision making.
影响因子：
2.9
作者：
Finnikin S;Ryan R;Marshall T
通讯作者：
Marshall T