Abstract 011: Physician-Level Variation in Lipid Management for Secondary Prevention of Atherosclerotic Cardiovascular Disease: Opportunities for Practice Improvement

Abstract

Introduction: While prior studies have documented suboptimal lipid therapeutic management and low rates of LDL-C goal achievement in patients with ASCVD, the degree of variability between cardiologists in lipid-lowering therapy (LLT) practice patterns is less well described. Hypothesis: Significant variability exists between cardiologists in their use of LLT and achievement of LDL-C goals in patients with ASCVD. Methods: We evaluated the use of LLTs and achievement of LDL-C <70 mg/dL among adults with ASCVD (peripheral arterial disease, coronary artery disease, or ischemic cerebrovascular disease) followed by a cardiologist at a large academic medical center from 1/1/22-6/30/24. LLT utilization and LDL-C goal achievement were modeled using mixed-effects logistic regression with clustering at the cardiologist level, adjusting for patient age, insurance, ASCVD type, and diabetes. From this model, we quantified physician-level variability using the adjusted median odds ratios (aMOR). Results: Among 10,531 patients with ASCVD (mean age 68.5 years, 61.1% male, 69.8% White) seen across 55 cardiologists, 80.6% were on any statin, 51.5% were on a high-intensity statin, 14.9% were on ezetimibe, 5.6% were on bempedoic acid or a PCSK9 inhibitor, and 15.1% were not on any LLT. Of those with a lipid panel in the past year (n= 7,555), 45.9% achieved an LDL-C < 70 mg/dL. Lipid management strategies varied substantially across cardiologists ( Figure ). In mixed-effects models adjusting for patient-level factors, significant physician-level variation was observed in high-intensity statin use (aMOR 1.33, 95% CI 1.25-1.45), ezetimibe use (aMOR 1.62, 95% CI 1.46-1.85), bempedoic acid or PCSK9 inhibitor use (aMOR 2.03, 95% CI 1.75-2.45), and attainment of LDL-C < 70 mg/dL (aMOR 1.27, 95% CI 1.20-1.38). Conclusion: Even among cardiologists at the same academic medical center, practice patterns varied widely in the use of LLT and achievement of LDL-C goals for secondary prevention. Understanding the reasons for this variability and standardizing lipid management across the specialty may improve quality of care for patients with ASCVD.