背景:他汀类药物处方应基于心血管疾病(CVD)风险,但有证据表明,低风险人群的过度治疗和高风险人群的治疗不足。
目的:探讨初级护理中的CVD风险评分与开始使用他汀类药物进行CVD一级预防之间的关系。以及2014年美国国家健康与护理卓越研究所(NICE)指南的变化的影响。
方法:使用英国电子初级保健记录的历史队列研究。
方法:在2000年1月1日至2015年12月31日期间,对没有心血管疾病的他汀类药物初治患者进行了队列研究。确定了CVD风险评分(使用QRISK2计算,从2012年开始)和他汀类药物的起始。计算CVD风险评分记录的比率,以及CVD风险类别(低,中介-,高风险:<10%,10-19.9%,和≥20%的10年CVD风险)和他汀类药物开始进行分析。
结果:从248个实践中确定了140万患者。其中,自2012年以来,有151788人记录了CVD风险评分(10.67%),有217860人开始使用他汀类药物(15.31%)。在2012年后开始服用他汀类药物的患者中,27.1%的患者有QRISK2评分:2.7%的低风险患者,中等风险的13.8%,35.0%的高危患者开始服用他汀类药物。他汀类药物起始率从2006年的峰值下降了一半。在2014年NICE指南之后,他汀类药物启动率在高危患者中下降,但在中危患者中增加。
结论:大多数开始服用他汀类药物的患者没有记录QRISK2评分。大多数心血管疾病高危患者未开始服用他汀类药物。六分之一的他汀类药物初始化是低风险患者,表明明显的过度治疗。在2014年更新NICE指南后,他汀类药物在中危患者中的起始量上升。
BACKGROUND: Statin prescribing should be based on cardiovascular disease (CVD) risk, but evidence suggests overtreatment of low-risk groups and undertreatment of high-risk groups.
OBJECTIVE: To investigate the relationship between CVD risk scoring in primary care and initiation of statins for the primary prevention of CVD, and the effect of changes to the National Institute for Health and Care Excellence (NICE) guidance in 2014.
METHODS: Historical cohort
study using UK electronic primary care records.
METHODS: A cohort was created of statin-naïve patients without CVD between 1 January 2000 and 31 December 2015. CVD risk scores (calculated using QRISK2 available from 2012) and statin initiations were identified. Rates of CVD risk score recording were calculated and relationships between CVD risk category (low-, intermediate-, and high-risk: <10%, 10-19.9%, and ≥20% 10-year CVD risk) and statin initiation were analysed.
RESULTS: A total of 1.4 million patients were identified from 248 practices. Of these, 151 788 had a recorded CVD risk score since 2012 (10.67%) and 217 860 were initiated on a statin (15.31%). Among patients initiated on a statin after 2012, 27.1% had a documented QRISK2 score: 2.7% of low-risk, 13.8% of intermediate-risk, and 35.0% of high-risk patients were initiated on statins. Statin initiation rates halved from a peak in 2006. After the 2014 NICE guidelines, statin initiation rates declined in high-risk patients but increased in intermediate-risk patients.
CONCLUSIONS: Most patients initiated on statins had no QRISK2 score recorded. Most patients at high risk of CVD were not initiated on statins. One in six statin initiations were to low-risk patients indicating significant overtreatment. Initiations of statins in intermediate-risk patients rose after NICE guidelines were updated in 2014.