The use of structured data elements to identify ASCVD patients with statin-associated side effects: Insights from the Department of Veterans Affairs
The use of structured data elements to identify ASCVD patients with statin-associated side effects: Insights from the Department of Veterans Affairs
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DOI：
10.1016/j.jacl.2019.08.002
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发表时间：
2019-10-01
影响因子：
4.4
通讯作者：
Petersen, Laura A.
中科院分区：
文献类型：
--
作者：
Virani, Salim S.;Akeroyd, Julia M.;Petersen, Laura A.
背景技术背景：准确识别患者与他汀类药物相关的副作用（SASE）是至关重要的卫生保健系统制定战略，以改善指南一致的他汀类药物的使用目的：本研究的目的是确定是否不良药物反应（ADR）输入的临床医生在电子病历可以准确地识别SASE。我们确定了1，248，214名在退伍军人事务部寻求护理的动脉粥样硬化性心血管疾病（ASCVD）患者。使用ADR数据库，我们确定了15个主要症状类别的SASE。通过对256例未接受高强度他汀类药物治疗的ASCVD患者进行回顾性分析，评估其敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。我们确定了171，189例（13.71%）在15年期间有记录的SASE的患者（分别为9.9%，2.7%和1.1%至1，2或>2种他汀类药物）。在有SASE的患者中，他汀类药物使用率、高强度他汀类药物使用率、低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇水平分别为72%、28.1%、99 mg/dL和129 mg/dL，而在无SASE的患者中分别为81%、31.1%、84 mg/dL和111 mg/dL。在对1、2或>2种他汀类药物有SASE的患者中，他汀类药物和高强度他汀类药物的使用逐渐减少，低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇水平升高。三分之二的SASE与肌肉症状有关。与手工病历审查相比，敏感性、特异性、PPV、NPV分别为63.4%、100%、100%和85.3%.CONCLUSION：在电子病历中使用ADR条目的策略是可行的，以识别具有中等敏感性和NPV但具有高特异性和PPV的SASE。卫生保健系统可以使用这种策略来识别ASCVD患者的SASE和操作的努力，以改善指南一致的降脂治疗使用这些患者。通过使用非结构化文本数据，可以进一步增强这种方法的灵敏度。爱思唯尔公司出版代表国家脂质协会
BACKGROUND: Accurate identification of patients with statin-associated side effects (SASEs) is critical for health care systems to institute strategies to improve guideline-concordant statin use.OBJECTIVE: The objective of this study was to determine whether adverse drug reaction (ADR) entry by clinicians in the electronic medical record can accurately identify SASEs.METHODS: We identified 1,248,214 atherosclerotic cardiovascular disease (ASCVD) patients seeking care in the Department of Veterans Affairs. Using an ADR data repository, we identified SASEs in 15 major symptom categories. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed using a chart review of 256 ASCVD patients with identified SASEs, who were not on high-intensity statin therapy.RESULTS: We identified 171,189 patients (13.71%) with documented SASEs over a 15-year period (9.9%, 2.7%, and 1.1% to 1, 2, or >2 statins, respectively). Statin use, high-intensity statin use, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol levels were 72%, 28.1%, 99 mg/dL, and 129 mg/dL among those with vs 81%, 31.1%, 84 mg/dL, and 111 mg/dL among those without SASEs. Progressively lower statin and high-intensity statin use, and higher low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol levels were noted among those with SASEs to 1, 2, or >2 statins. Two-thirds of SASEs were related to muscle symptoms. Sensitivity, specificity, PPV, NPV compared with manual chart review were 63.4%, 100%, 100%, and 85.3%, respectively.CONCLUSION: A strategy of using ADR entry in the electronic medical record is feasible to identify SASEs with modest sensitivity and NPV but high specificity and PPV. Health care systems can use this strategy to identify ASCVD patients with SASEs and operationalize efforts to improve guideline-concordant lipid-lowering therapy use in such patients. The sensitivity of this approach can be further enhanced by the use of unstructured text data. Published by Elsevier Inc. on behalf of National Lipid Association.