Lipid-lowering Therapy Utilization, Adherence, and Outcomes Among Adults With and at-Risk for Atherosclerotic Cardiovascular Disease in an Integrated Healthcare Delivery System in Southern California.

Despite their safety and effectiveness, lipid-lowering therapy (LLT) remains underutilized among adults with and at-risk for atherosclerotic cardiovascular disease (ASCVD) in terms of prescriber-guideline concordance and patient adherence. We examined LLT use, adherence, and outcomes among primary and secondary prevention populations. Adults ≥21 years of age in Kaiser Permanente Southern California with a history of ASCVD or intermediate (≥7.

Safety Net Program to Improve Statin Initiation Among Adults With High Low-Density Lipoprotein Cholesterol.

Introduction: Despite their effectiveness in reducing low-density lipoprotein cholesterol and cardiovascular disease risk, high-intensity statins are underutilized among adults with low-density lipoprotein cholesterol ≥190 mg/dL. This study determined whether a safety net program (SureNet) facilitating medication and laboratory test orders improved statin initiation and laboratory test completions after (SureNet period: April 2019-September 2021) and before implementation (pre-SureNet period: January 2016-September 2018).

Methods: Kaiser Permanente Southern California members aged 20-60 years with low-density lipoprotein cholesterol ≥190 mg/dL and no statin use in previous 2-6 months were included in this retrospective cohort study.

Trends in Acute Myocardial Infarction by Race and Ethnicity.

Background Trends in acute myocardial infarction (AMI) incidence rates for diverse races/ethnicities are largely unknown, presenting barriers to understanding the role of race/ethnicity in AMI occurrence. Methods and Results We identified AMI hospitalizations for Kaiser Permanente Southern California members, aged ≥35 years, during 2000 to 2014 using discharge diagnostic codes. We excluded hospitalizations with missing race/ethnicity information.

Sex-Specific Trends in Acute Myocardial Infarction Within an Integrated Healthcare Network, 2000 Through 2014.

Background: In recent decades, the rates of incident acute myocardial infarction (AMI) have declined in the United States, yet disparities by sex remain. In an integrated healthcare delivery system, we examined temporal trends in incident AMI among women and men.

Methods: We identified hospitalized AMI among members ≥35 years of age in Kaiser Permanente Southern California.

Trends in Lipid Screening Among Adults in an Integrated Health Care Delivery System, 2009-2015.

Background: Lipid screening determines eligibility for statins and other cardiovascular risk reduction interventions.

Objective: To examine trends in lipid screening among adults aged ≥20 years in a large, multiethnic, integrated health care delivery system in southern California.

Methods: Temporal trends in lipid screening were examined from 2009 to 2015 with an index date of September 30 of each year.

Trends in Statin Use 2009-2015 in a Large Integrated Health System: Pre- and Post-2013 ACC/AHA Guideline on Treatment of Blood Cholesterol.

Purpose: Implementation of the 2013 ACC/AHA cholesterol treatment guideline is likely to vary by statin benefit group. The aim of this study was to document trends in statin use before and after introduction of the ACC/AHA guideline.

Methods: We conducted a retrospective study with annual cohorts from 2009 to 2015 among members of Kaiser Permanente Southern California aged ≥ 21 years.

Unmet Patient Need in Statin Intolerance: the Clinical Characteristics and Management.

Purpose: A substantial percentage of patients report intolerance or side effects of statin treatment leading to treatment changes or discontinuation. The purpose of this study was to examine statin therapy changes and subsequent effects on low-density lipoprotein cholesterol (LDL-C) among patients with statin intolerance (SI).

Methods: We identified 45,037 adults from Kaiser Permanente Southern California with SI documented between 2006 and 2012.

Severe hypertriglyceridemia and factors associated with acute pancreatitis in an integrated health care system.

Objective: To evaluate patient characteristics, treatment patterns, comorbidities, and risk factors associated with the development of acute pancreatitis (AP) in patients with severe hypertriglyceridemia (HTG) in an integrated health care delivery system.

Methods: We identified a retrospective cohort of severe HTG patients with a fasting triglyceride level ≥ 1000 mg/dL during January 1, 2007 to June 30, 2013 (index date) in an integrated health care delivery system. Patients were aged ≥18 years on index date and had 12 months of continuous membership and drug eligibility before the index date and during postindex including index date.

All-Cause and Acute Pancreatitis Health Care Costs in Patients With Severe Hypertriglyceridemia.

Objective: The aim of this study was to assess health care utilization and costs related to acute pancreatitis (AP) in patients with severe hypertriglyceridemia (sHTG) levels.

Methods: Patients with sHTG levels 1000 mg/dL or higher were identified from January 1, 2007, to June 30, 2013. The first identified incident triglyceride level was labeled as index date.

Automated Outreach for Cardiovascular-Related Medication Refill Reminders.

The objective of this study was to evaluate the effectiveness of an automated telephone system reminding patients with hypertension and/or cardiovascular disease to obtain overdue medication refills. The authors compared the intervention with usual care among patients with an overdue prescription for a statin or lisinopril-hydrochlorothiazide (lisinopril-HCTZ). The primary outcome was refill rate at 2 weeks.

Adherence to statins and LDL-cholesterol goal attainment.

Objectives: To examine the relationship between low-density lipoprotein cholesterol (LDL-C) goal attainment and adherence to statin medications in patients with coronary artery disease (CAD).

Study Design: Cross-sectional study of CAD patients 18 years of age or older in an integrated healthcare system.

Methods: Patients dispensed 2 or more statin prescriptions between May 2009 and May 2010, were identified.

Leveraging the electronic medical record to implement an abdominal aortic aneurysm screening program.

Objective: Screening for abdominal aortic aneurysms (AAAs) reduces aneurysm-related mortality and has been recommended by the U.S. Preventive Services Task Force and American Heart Association since 2005.

Use of health information technology (HIT) to improve statin adherence and low-density lipoprotein cholesterol goal attainment in high-risk patients: proceedings from a workshop.

The workshop discussions focused on how low-density lipoprotein cholesterol (LDL-C) goal attainment can be enhanced with the use of health information technology (HIT) in different clinical settings. A gap is acknowledged in LDL-C goal attainment, but because of the passage of the American Recovery & Reinvestment Act and the Health Information Technology for Economic and Clinical Health Acts there is now reason for optimism that this gap can be narrowed. For HIT to be effectively used to achieve treatment goals, it must be implemented in a setting in which the health care team is fully committed to achieving these goals.

Primary nonadherence to statin therapy: patients' perceptions.

Objectives: To identify self-reported reasons for not filling a new prescription for statin therapy.

Study Design: A cross-sectional telephone survey.

Methods: Potential participants were identified from a randomized, controlled trial among Kaiser Permanente Southern California (KPSC) members aged >24 years with no record of redeeming a new statin medication, defined as primary nonadherence.

Primary nonadherence to statin medications in a managed care organization.

Background: Primary nonadherence to a medication occurs when a drug is prescribed but the patient fails to pick the prescription up from the pharmacy. Managed care organizations that provide integrated care using electronic medical records (EMR) are an ideal setting to study primary nonadherence. 

Objective: To identify patient and provider characteristics that are significantly associated with primary nonadherence to statin medications compared with a population of patients who picked up their first statin order.

Automated outreach to increase primary adherence to cholesterol-lowering medications.

Background: Primary nonadherence occurs when new prescriptions are not dispensed. Little is known about how to reduce primary nonadherence. We performed a randomized controlled trial to evaluate an automated system to decrease primary nonadherence to statins for lowering cholesterol.