More elderly patients at risk for congestive heart failure are getting aggressive statin therapy when they need it. Researchers from Kaiser Permanente Center for Health Research in Portland, Oregon, say that the 2004 update to the National Cholesterol Education Program Adult Treatment Panel III guidelines and the corresponding revision of internal guidelines in the large health maintenance organization they studied resulted in more patients receiving minimal-guideline statin therapy.
The investigators analyzed records of 14,425 elderly patients who received statins in 2003 and 19,422 who received treatment in 2005. Among patients at very high risk, 10% of new statin users and 19% of ongoing users received aggressive therapy in 2005, compared with 3% and 12% in 2003.
Overall, among new statin users, 85% at high risk for heart failure received minimal-guideline therapy in 2005, compared with 65% in 2003. Of ongoing users, 78% received minimal-guideline therapy in 2005, compared with 59% in 2003.
The increase in the proportion receiving minimal-guideline therapy did not mean that more patients attained their low-density lipoprotein-cholesterol (LDL-C) goals, however—perhaps because older patients rarely received intensive statin therapy, the researchers suggest. Even though aggressive therapy was more common after the guidelines were revised, only a minority of patients received it, even among those at very high risk for congestive heart failure. Neither the updated guidelines nor Kaiser Permanente’s revised guidelines explicitly recommend intensive therapy, the researchers say, “opting instead for a recommendation of therapy expected to decrease LDL-C by 30% to 40%.”
Source: Am Heart J 2007