Acclimating to the Increase in Statin Use in Accountable Care Organizations Based on Changes in Quality Measures: A Report from the Accountable Care Organization Research Network, Services, and Education.

The Accountable Care Organization Research Network, Services, and Education (ACORN SEED), founded by faculty members at Nova Southeastern University College of Pharmacy, is a group of pharmacists that provides unique pharmacy services to accountable care organizations (ACOs), patient-centered medical homes, and management services organizations to help maximize shared savings and target medication-related issues, while promoting the pharmacy profession and unique learning experiences for pharmacy students within these settings. In this report, ACORN SEED investigators provide a brief overview of the ACO benchmark measures in relation to statin use. Historically, hyperlipidemia treatment was tailored to meet certain cholesterol levels as a surrogate marker in preventing major adverse cardiovascular events, specifically a low-density lipoprotein cholesterol (LDL-C) level less than 100 mg/dL as a target goal. In addition, Medicare assessed a health care provider's performance based on this target goal in specific populations (i.e., diabetes and ischemic vascular disease). In 2013, the American College of Cardiology and American Heart Association published updated recommendations removing these LDL-C treatment goals. Rather than treating with cholesterol-lowering medications in an effort to reduce cholesterol levels, patients are now being evaluated for statin therapy use based on 4 benefit groups that focus on the risk of atherosclerotic cardiovascular disease. In 2015, Medicare's shared savings program removed the previous LDL-C goals from its quality measures and now assesses positive performance from the updated guidelines. Currently, under ACO benchmark measure #42, health care providers are being rewarded for prescribing statin therapy for the prevention and treatment of cardiovascular disease, which reflects updated evidence-based recommendations. With the increase in statin use, randomized controlled trials or ACO validation studies are important in determining future implications on cardiovascular outcomes. DISCLOSURES: No funding was involved in the preparation of this report. The authors have no conflicts of interest to declare. Both authors contributed equally to data collection, analysis, and manuscript preparation.

The use of metformin in patients with prostate cancer and the risk of death.

BACKGROUND: Given the conflicting results from observational studies, we assessed whether the use of metformin after a prostate cancer diagnosis is associated with a decreased risk of cancer-specific and all-cause mortality. METHODS: This study was conducted linking four databases from the United Kingdom. A cohort of men newly diagnosed with nonmetastatic prostate cancer with a history of treated type II diabetes, between April 1, 1998 and December 31, 2009, was followed until October 1, 2012. Nested case-control analyses were performed for cancer-specific mortality and all-cause mortality, in which exposure was defined as use of metformin during the time to risk-set. Conditional logistic regression was used to estimate adjusted rate ratios (RR) of each outcome with 95% confidence intervals (CI). RESULTS: The cohort consisted of 935 men with prostate cancer and a history of type II diabetes. After a mean follow-up of 3.7 years, 258 deaths occurred, including 112 from prostate cancer. Overall, the post-diagnostic use of metformin was not associated with a decreased risk of cancer-specific mortality (RR, 1.09; 95% CI, 0.51-2.33). In a secondary analysis, a cumulative duration ≥938 days was associated with an increased risk (RR, 3.20; 95% CI, 1.00-10.24). The post-diagnostic use of metformin was not associated with all-cause mortality (RR, 0.79; 95% CI, 0.50-1.23). CONCLUSION: The use of metformin after a prostate cancer diagnosis was not associated with an overall decreased risk of cancer-specific and all-cause mortality. IMPACT: The results of this study do not support a role for metformin in the prevention of prostate cancer outcomes.

Type 2 diabetes and the risk of mortality among patients with prostate cancer.

PURPOSE: The aim of this study was to determine whether type 2 diabetes is associated with the incidence of prostate cancer mortality and all-cause mortality. METHODS: This study was conducted by linking four databases from the United Kingdom: the National Cancer Data Repository, the Clinical Practice Research Datalink, the Hospital Episodes Statistics database, and the Office for National Statistics database. The cohort consisted of men newly diagnosed with non-metastatic prostate cancer between 1 April 1998 and 31 December 2009, followed until 1 October 2012. Cox proportional hazard models were used to estimate adjusted hazard ratios with 95 % confidence intervals (CIs) of prostate cancer mortality and all-cause mortality comparing patients with to without type 2 diabetes. All models were adjusted for a number of potential confounders, which included excessive alcohol use, smoking, comorbidities, and prostate cancer-related variables. RESULTS: The cohort consisted of 11,920 patients, which included 1,132 (9.5 %) with preexisting type 2 diabetes. During a mean follow-up of 4.7 (SD 3.0) years, there were 3,605 deaths (incidence rate: 6.4 %/year) including 1,792 from prostate cancer (incidence rate: 3.3 %/year). Type 2 diabetes was associated with a 23 % increased risk of prostate cancer mortality (HR 1.23, 95 % CI 1.04-1.46) and a 25 % increased risk in all-cause mortality (HR 1.25, 95 % CI 1.11-1.40). CONCLUSIONS: The results of this large population-based study indicate that type 2 diabetes is associated with an increased risk of prostate cancer mortality and all-cause mortality, which may signal an association between hyperinsulinemia or other diabetes-associated metabolic derangements and cancer aggressivity.