• Sebastian T Tong, Roy T Sabo, Camille J Hochheimer, E Marshall Brooks, Vivian Jiang, Alison N Huffstetler, Lail KashiriPaulettePFrom the Agency for Healthcare Research and Quality, Rockville, MD (STT); Virginia Commonwealth University, Richmond, VA (RTS, EMB, ANH, PLL, AHK); University of Virginia, Charlottesville, VA (CJH); University of Colorado, Boulder, CO, and Alex H Krist.
• From the Agency for Healthcare Research and Quality, Rockville, MD (STT); Virginia Commonwealth University, Richmond, VA (RTS, EMB, ANH, PLL, AHK); University of Virginia, Charlottesville, VA (CJH); University of Colorado, Boulder, CO (VJ).
• J Am Board Fam Med. 2021 Jan 1; 34 (1): 113-122.

IntroductionIn December 2013, cholesterol treatment guidelines changed the approach to statin therapy by recommending fixed doses of low-, medium-, or high-intensity statins based on cardiovascular risk. We sought to evaluate the guideline's adoption in a diverse group of practices.MethodsUsing a mixed-methods approach, we analyzed electronic health record data the year before and 2 years following guideline publication in 45 practices across 8 states. We examined associations based on patient, clinician, and practice characteristics and interviewed 24 clinicians and practice leaders to inform findings.ResultsThe proportion of patients adherent with all recommendations 2 years after the guideline only increased from 18.5% to 20.3% (P < .01). There were clinically insignificant increases in statin use across risk strata (1.7% to 3.5%) and small increases in high-intensity statin use (2.6% to 4.6%). Only half of patients with cardiovascular disease (52.9%) were on any statin, not much different from patients at moderate (49.6% to 50.9%) or low (41.6% to 48.7%) risk. Multiple patient (risk, use of health care), clinician (age), and practice (type, rurality) factors were associated with statin use. Clinicians reported patient resistance to statins but liked having a risk calculator to guide discussions.ConclusionDespite general agreement with statin benefit, the guideline was poorly implemented. Marginal differences in statin use between the highest and lower risk strata of patients is concerning. Rather than intensifying statin potency and recommending more patients take statins, guidelines may want to focus on ensuring that those who will benefit most get treatment.© Copyright 2021 by the American Board of Family Medicine.

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