title: In-hospital statin underutilization among high-risk patients: delayed uptake of the 2013 cholesterol guidelines in a U.S. cohort.
abstract: OBJECTIVE
  Clinician utilization of the 2013 cholesterol lowering guidelines remains variable and unknown. We sought to examine statin prescribing patterns and compare rates among specialists who treat high-risk cardiovascular patients admitted to the hospital.
  
  
  METHODS
  We retrospectively (via chart review) examined four specialty groups: (i) Cardiology, (ii) Cardiovascular or Vascular (CV) Surgery, (iii) Neurology, and (iv) Internal Medicine. Adult patients were included based on a discharge diagnosis of acute coronary syndrome, coronary artery bypass graft surgery, carotid endarterectomy, acute ischemic stroke, transient ischemic attack, or high-risk chest pain. Prescribing patterns were evaluated 6 months and 18 months after the release of the 2013 guidelines. High-intensity statin was defined as atorvastatin 40-80 mg or rosuvastatin 20-40 mg per day.
  
  
  RESULTS
  632 patients were included in our study. The following percentages of patients were discharged on high-intensity statin (6 months; 18 months): (i) Cardiology (80%; 85%), (ii) CV Surgery (52%, 65%), (iii) Neurology (59%; 66%), and (iv) Internal Medicine (45%; 48%). Among the four groups, Cardiology was the most likely to discharge patients on high-intensity statin (p < 0.001) in 2014 and in 2015. Cardiology, CV Surgery, and Neurology significantly increased the percentage of patients on high-intensity statin from pre-admission to time of discharge in both years.
  
  
  CONCLUSIONS
  High-intensity statin therapy is underutilized among high-risk cardiovascular patients admitted to the hospital. Variations exist in prescribing patterns of different specialties who manage high-risk populations. This data can be used to test quality improvement interventions to improve rates of high-intensity statin utilization among high-risk patients prior to hospital discharge.
authors.affiliation: a Department of Internal Medicine , Ronald Reagan UCLA Medical Center , Los Angeles , CA , USA.
authors.forename: Subeer K
authors.initials: SK
authors.lastname: Wadia
authors.affiliation: b Department of Internal Medicine , University of Chicago Pritzker School of Medicine , Chicago , IL , USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Belkin
authors.affiliation: c Department of Internal Medicine , Rush University Medical Center , Chicago , IL , USA.
authors.forename: Kelsey S
authors.initials: KS
authors.lastname: Chow
authors.affiliation: d Department of Internal Medicine , University of Southern California Keck School of Medicine , Los Angeles , CA , USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Nattiv
authors.affiliation: e Division of Cardiology, Rush University Medical Center , Chicago , IL , USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Appis
authors.affiliation: e Division of Cardiology, Rush University Medical Center , Chicago , IL , USA.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Feinstein
authors.affiliation: e Division of Cardiology, Rush University Medical Center , Chicago , IL , USA.
authors.forename: Kim Allan
authors.initials: KA
authors.lastname: Williams
mesh_terms: D015331:Cohort Studies; D003327:Coronary Disease / Q000188:drug therapy* / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Statin; guideline; high-intensity; inpatient