TY - JOUR
T1 - Predictors of PCSK9 (Proprotein Convertase Subtilisin/Kexin Type 9) Inhibitor Prescriptions for Secondary Prevention of Clinical Atherosclerotic Cardiovascular Disease
AU - Blumenthal, Daniel M.
AU - Maddox, Thomas M.
AU - Aragam, Krishna
AU - Sacks, Chana A.
AU - Virani, Salim S.
AU - Wasfy, Jason H.
N1 - Funding Information:
This research was supported by the American College of Cardiology's National Cardiovascular Data Registry (NCDR). The views expressed in this article represent those of the author(s) and do not necessarily represent the official views of the NCDR or its associated professional societies identified at CVQuality. ACC.org/NCDR. The National Practice Innovation and Clinical Excellence (PINNACLE) registry is an initiative of the American College of Cardiology. Bristol-Myers Squibb and Pfizer, Inc are founding sponsors of the PINNACLE registry. Dr Wasfy is supported by a grant from the American Heart Association (18 CDA 34110215).
Funding Information:
Dr Wasfy discloses serving as the vice-chair of the New England Comparative Effectiveness Public Affairs Council (New England CEPAC), which has evaluated cost-effectiveness of PCSK9i. Dr Wasfy also reports participation in an advisory board for Pfizer. Dr Blumenthal discloses working as Chief Executive Officer of Coeur Value/Novocardia LLC, having previously worked as the Associate Chief Medical Officer and National Medical Director for Devoted Health, Inc, which is a Medicare Advantage Health Insurance Plan, and previously providing consulting services for Devoted Health Inc (January–Feburary 2020), Precision Health Economics (2016–2017), Amgen (2016–2017), and Novartis (2016–2017). Dr Maddox discloses current grant funding from the NIH NCATS (1U24TR002306-01: A National Center for Digital Health Informatics Innovation), current consulting for Creative Educational Concepts, Inc. and Atheneum Partners, and honoraria and expense reimbursement in the past 3 years from the University of Utah (May 2017), New York Presbyterian (September 2017), Westchester Medical Center (October 2017), Sentara Heart Hospital (December 2018), the Henry Ford Health System (March 2019), and the University of California San Diego (January 2020). He is currently employed as a cardiologist and the executive director of the Healthcare Innovation Lab at BJC HealthCare/Washington University School of Medicine. In this capacity, he is advising Myia Labs, for which his employer is receiving equity compensation in the company. He is receiving no individual compensation from the company. He is also a compensated director for a New Mexico-based foundation, the J.F Maddox Foundation. Dr Virani discloses grant support from the United States Department of Veterans Affairs, the World Heart Federation, and the Tahir and Jooma families. Dr Virani also discloses receiving honorarium from the American College of Cardiology for serving as the Associate Editor for Innovations at acc.org. The other authors report no conflicts.
Funding Information:
This research was supported by the American College of Cardiology’s National Cardiovascular Data Registry (NCDR). The views expressed in this article represent those of the author(s) and do not necessarily represent the official views of the NCDR or its associated professional societies identified at CVQuality.ACC.org/NCDR. The National Practice Innovation and Clinical Excellence (PINNACLE) registry is an initiative of the American College of Cardiology. Bristol-Myers Squibb and Pfizer, Inc are founding sponsors of the PINNACLE registry. Dr Wasfy is supported by a grant from the American Heart Association (18 CDA 34110215).
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Background: Little is known about patterns of PCSK9i (proprotein convertase subtilisin/kexin type 9 inhibitor) use among patients with established clinical atherosclerotic cardiovascular disease. This study's objective was to describe PCSK9i prescribing patterns among patients with atherosclerotic cardiovascular disease. Methods: We used a national outpatient clinic registry linked to zip-code level on household income from the US Census to assess characteristics of patients with atherosclerotic cardiovascular disease and LDL-C (low-density lipoprotein cholesterol) <190 mg/dL between September 1, 2015, and September 30, 2019, who did and did not receive PCSK9i prescriptions and practice-level and temporal variation in PCSK9i prescriptions. We assessed predictors of PCSK9i prescription with a multivariable mixed effects regression model which included patient covariates as fixed effects and the cardiology practice as a random effect. Adjusted practice-level variation in PCSK9i prescribing was evaluated with median odds ratio (OR). Results: Of 2 148 100 patients meeting study inclusion criteria, 27 249 (1.3%) received PCSK9i prescriptions. Receiving a PCSK9i prescription was associated with White race (versus non-White: OR, 1.78 [95% CI, 1.55-1.83]); high estimated household income (versus low income: OR, 1.18 [95% CI, 1.08-1.29]), and urban or suburban (versus rural) practice location (urban: OR, 1.47 [95% CI, 1.32-1.64]; suburban: OR, 1.25 [95% CI, 1.13-1.39]). Hispanics had lower odds of receiving PCSK9i prescriptions (OR, 0.66 [95% CI, 0.57-0.76]). The adjusted median odds ratio was 2.68 (95% CI, 2.46-2.94), consistent with clinically significant practice-level variation in PCSK9i prescriptions. No differences in quarterly PCSK9i prescription rates were observed before and after price reductions for evolocumab and alirocumab initiated during the fourth quarter of 2018 and first quarter of 2019, respectively. Conclusions: This study highlights racial, socioeconomic, geographic, and practice-level variations in early PCSK9i prescriptions which persist despite adjustment for clinical and demographic factors. After adjustment, 2 randomly selected practices would differ in likelihood of PCSK9i prescription by a factor of >2.
AB - Background: Little is known about patterns of PCSK9i (proprotein convertase subtilisin/kexin type 9 inhibitor) use among patients with established clinical atherosclerotic cardiovascular disease. This study's objective was to describe PCSK9i prescribing patterns among patients with atherosclerotic cardiovascular disease. Methods: We used a national outpatient clinic registry linked to zip-code level on household income from the US Census to assess characteristics of patients with atherosclerotic cardiovascular disease and LDL-C (low-density lipoprotein cholesterol) <190 mg/dL between September 1, 2015, and September 30, 2019, who did and did not receive PCSK9i prescriptions and practice-level and temporal variation in PCSK9i prescriptions. We assessed predictors of PCSK9i prescription with a multivariable mixed effects regression model which included patient covariates as fixed effects and the cardiology practice as a random effect. Adjusted practice-level variation in PCSK9i prescribing was evaluated with median odds ratio (OR). Results: Of 2 148 100 patients meeting study inclusion criteria, 27 249 (1.3%) received PCSK9i prescriptions. Receiving a PCSK9i prescription was associated with White race (versus non-White: OR, 1.78 [95% CI, 1.55-1.83]); high estimated household income (versus low income: OR, 1.18 [95% CI, 1.08-1.29]), and urban or suburban (versus rural) practice location (urban: OR, 1.47 [95% CI, 1.32-1.64]; suburban: OR, 1.25 [95% CI, 1.13-1.39]). Hispanics had lower odds of receiving PCSK9i prescriptions (OR, 0.66 [95% CI, 0.57-0.76]). The adjusted median odds ratio was 2.68 (95% CI, 2.46-2.94), consistent with clinically significant practice-level variation in PCSK9i prescriptions. No differences in quarterly PCSK9i prescription rates were observed before and after price reductions for evolocumab and alirocumab initiated during the fourth quarter of 2018 and first quarter of 2019, respectively. Conclusions: This study highlights racial, socioeconomic, geographic, and practice-level variations in early PCSK9i prescriptions which persist despite adjustment for clinical and demographic factors. After adjustment, 2 randomly selected practices would differ in likelihood of PCSK9i prescription by a factor of >2.
KW - alirocumab
KW - atherosclerosis
KW - cardiovascular disease
KW - cholesterol
KW - evolocumab
KW - prescriptions
UR - http://www.scopus.com/inward/record.url?scp=85116390020&partnerID=8YFLogxK
U2 - 10.1161/CIRCOUTCOMES.120.007237
DO - 10.1161/CIRCOUTCOMES.120.007237
M3 - Article
C2 - 34404223
AN - SCOPUS:85116390020
SN - 1941-7713
VL - 14
SP - E007237
JO - Circulation: Cardiovascular Quality and Outcomes
JF - Circulation: Cardiovascular Quality and Outcomes
IS - 9
ER -