In ASCVD, women ‘consistently underprescribed’ statins compared with men
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Key takeaways:
- Women with atherosclerotic heart disease were less likely than men to receive a statin prescription.
- Women were also more likely to be considered statin-intolerant than men in clinical notes.
Compared with men, women with atherosclerotic CVD were less likely to be prescribed any statin, less likely to be prescribed a high-intensity statin and more likely to be deemed statin-intolerant, electronic health records data show.
“Women with ASCVD are consistently underprescribed statins compared to men,” Fatima Rodriguez, MD, MPH, FACC, FAHA, FASPC, associate professor in cardiovascular medicine, and Celeste Witting, MD, an internal medicine resident, both of Stanford University, told Healio. “Using natural language processing to extract information about reasons for statin nonprescriptions in clinical notes, we found that discussions about statin use were less likely to happen for women, and that the reasons for statin underprescription were multifactorial, including patient and clinician factors. Women were more likely to have documentation of statin intolerance as a reason for not being on statins.”
Data were derived from Witting C, et al. J Am Prev Cardiol. 2023;doi:10.1016/j.ajpc.2023.100496.
Rodriguez, Witting and colleagues analyzed electronic health records data from 88,913 patients with a diagnosis of ASCVD and two or more encounters between 2014 and 2021. The mean age of patients was 68 years and 40.4% were women. After reviewing structured EHR prescription data, the researchers used a deep learning NLP approach, Clinical Bidirectional Encoder Representations from Transformers (BERT), to identify and interpret discussions of statin prescriptions documented in clinical notes.
The findings were published in the American Journal of Preventive Cardiology.
Women with ASCVD were less likely to be prescribed statins compared with men with ASCVD (56.6% vs. 67.6%; P < .002). When statins were prescribed, women were less likely to receive high-intensity dosing (41.4% vs. 49.8%; P < .001). Researchers noted that these disparities were more pronounced among women who were younger, had private insurance or did not speak English as a primary language.
Among patients who were not prescribed statins, women were less likely than men to have statin use reported in their clinical notes despite the absence of a recorded prescription (32.8% vs. 42.6%; P < .001). Women were also more likely to be deemed statin intolerant in structured data or clinical notes compared with men (6% vs. 5.3%; P = .003).
“Our work shows that there needs to be additional efforts to narrow disparities in statin use among women, since less than half of these high-risk women in the study were prescribed guideline-directed high-intensity statins,” Rodriguez and Witting told Healio. “NLP and increasingly popular large language models may be used to analyze large volumes of clinical data to generate greater insights into factors that contribute to sex-based care gaps in CVD disease management. Identifying drivers of disparities can allow targeted interventions that promote health equity.”
“There is a critical need for implementation science research that tests patient, clinician and system interventions to eliminate the persistent gender disparity in statin prescription for patients with ASCVD,” Rodriguez and Witting told Healio.
For more information:
Fatima Rodriguez, MD, MPH, FACC, FAHA, FASPC, can be reached at frodrigu@stanford.edu; Twitter: @farodriguezmd.
Celeste Witting, MD, can be reached at cwitting@stanford.edu; Twitter: @celestewitting.
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