Clinical action measure may improve appropriate statin use

Most patients with diabetes are receiving appropriate treatment for dyslipidemia, but nearly 14% are potentially overtreated with high-dose statins, new data show. A performance measure based on clinical action vs. target LDL levels may help avoid this problem, researchers reported.

“Performance measures that emphasize only a treat-to-target approach may motivate overtreatment with high-dose statins, potentially leading to adverse events and unnecessary costs,” researchers wrote in Circulation: Cardiovascular & Quality Outcomes. “We developed a clinical action performance measure for lipid management in patients with diabetes mellitus that is designed to encourage appropriate treatment with moderate-dose statins while minimizing overtreatment.”

The researchers’ clinical action performance measure for patients aged 50 to 75 years included the following criteria:

Having LDL <100 mg/dL.
Taking a moderate-dose statin regardless of LDL or measurement.
Receiving appropriate clinical action, including starting, switching or intensifying statin therapy, if LDL ≥100 mg/dL.

Overtreatment was determined by assessing the proportion of patients without ischemic heart disease who were taking a high-dose statin.

Of 964,818 active Veterans Affairs primary care patients with diabetes examined from 2010 to 2011, 668,209 were aged 50 to 75 years. The researchers found the following among the 84.6% of these patients who passed the clinical action measure:

67.2% had LDL <100 mg/dL.
13% had LDL ≥100 mg/dL and were on a moderate-dose statin (7.5%) or other appropriate clinical action (5.5%).
4.4% had no index LDL and were on at least a moderate-dose statin.

Of all patients aged 18 years or older, 13.7% were potentially overtreated, according to the researchers. They also found that facilities with higher rates of meeting the current threshold measure of LDL <100 mg/dL had higher rates of potential overtreatment.

“High rates of passing the action measure are reflective of both the comprehensive structure of the clinical action measure and the high-performing health care system. However, the pattern of use of high-dose statins among patients without [ischemic heart disease] indicates that providers may be overusing high-dose statins to achieve the current threshold LDL targets. Use of the clinical action measure has the potential to enhance more appropriate treatment over time by de-emphasizing the attainment of an LDL target and motivating moderate-dose statin use,” the researchers wrote.

For more information:

Beard AJ. Circ Cardiovasc Qual Outcomes. 2012;doi:10.1161/CIRCOUTCOMES.112.966697.

Disclosure: Two of the researchers report receiving research grants.