RESUMO
PURPOSE: This study aimed to evaluate associations between outpatient low-density lipoprotein cholesterol (LDL-C) testing and subsequent statin adherence and intensification in patients after an atherosclerotic cardiovascular (ASCVD) event. METHODS: This was a longitudinal study of adult members of Kaiser Permanente Northern California hospitalized with an ASCVD event (myocardial infarction or stroke) during January 01, 2016, to December 31, 2017, with follow-up through December 31, 2019. Outcomes were statin adherence (estimated using continuous medication gap [CMG]) and intensification (defined by an increased dose or switch to a higher-intensity statin) based on pharmacy dispensing. The exposure of interest was first outpatient LDL-C test after an ASCVD event. Baseline for follow-up was LDL-C test date or a date assigned using incidence density sampling. Multivariate logistic regression models were specified to estimate the odds ratios for statin adherence or intensification among those with vs without an LDL-C test, with adjustment for age, sex, race/ethnicity, smoking, hypertension, diabetes, body mass index, and estimated glomerular filtration rate. RESULTS: There were 19,604 adults hospitalized with ASCVD, including 7054 adults not on high-intensity statins. The mean age was 69.5 years and 33.0% were female. Prevalence of good adherence (continuous medication gap ≤20%) was significantly higher (80.2% vs 75.9%; odds ratio 1.38; 95% confidence interval, 1.28-1.49; P <.001) among participants who had an LDL-C test compared with participants who did not. LDL-C testing was associated with significantly higher rates of treatment intensification (16.1% vs 10.7%; odds ratio 1.51; 95% confidence interval,1.29-1.76; P <0.001). CONCLUSIONS: Low-density lipoprotein cholesterol testing is recommended for patients with a history of ASCVD and may be a high-value and low-cost intervention to improve adherence and statin management.
Assuntos
Aterosclerose , Doenças Cardiovasculares , LDL-Colesterol , Inibidores de Hidroximetilglutaril-CoA Redutases , Infarto do Miocárdio , Acidente Vascular Cerebral , Adulto , Idoso , Aterosclerose/tratamento farmacológico , Aterosclerose/epidemiologia , Aterosclerose/prevenção & controle , Doenças Cardiovasculares/tratamento farmacológico , LDL-Colesterol/sangue , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Estudos Longitudinais , Masculino , Adesão à Medicação , Infarto do Miocárdio/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológicoRESUMO
BACKGROUND AND PURPOSE: Electrocardiographic abnormalities are common after subarachnoid hemorrhage, but their significance remains uncertain. The aim of this study was to determine whether any specific electrocardiographic abnormalities are independently associated with adverse neurological outcomes. METHODS: This was a substudy of the Intraoperative Hypothermia Aneurysm Surgery Trial, which was designed to determine whether intraoperative hypothermia would improve neurological outcome in patients with subarachnoid hemorrhage undergoing aneurysm surgery. The outcome was the 3-month Glasgow Outcome Score treated as both a categorical measure (Glasgow Outcome Score 1 [good outcome] to 5 [death]) and dichotomously (mortality/Glasgow Outcome Score 5 versus Glasgow Outcome Score 1 to 4). The predictor variables were preoperative electrocardiographic characteristics, including heart rate, corrected QT interval, and ST- and T-wave abnormalities. Univariate logistic regression was performed to screen for significant electrocardiographic variables, which were then tested for associations with the outcome by multivariate logistic regression adjusting for clinical covariates. RESULTS: The study included 588 patients, of whom 31 (5%) died. There was a significant, nonlinear association between heart rate and mortality such that lowest quartile (