# Determining and targeting reasons for low statin use to improve guideline-concordant statin therapy in high-risk patients

> **NIH VA I01** · MICHAEL E DEBAKEY VA MEDICAL CENTER · 2020 · —

## Abstract

Background: Optimal statin therapy is associated with a lower risk of cardiovascular events in patients with
established cardiovascular disease (CVD). The VA External Peer Review Program (EPRP) also recommends
moderate-high intensity statins in patients with CVD. We have shown that a large proportion of Veterans with
CVD (41%) are on suboptimal statin therapy. Guideline concordant statin treatment over 5 years could
potentially prevent 20,611 vascular events including 3,435 deaths in Veterans with CVD. Suboptimal statin use
may be due to statin associated side effects or due to provider clinical inertia. We have shown that side effects
and statin intolerance are not well captured in the structured datasets, and are usually documented in the free
text notes by clinicians. It is therefore important to identify the reasons for suboptimal statin utilization and to
design an intervention to increase receipt of guideline recommended care in appropriate CVD patients.
Objective: Our objective is to examine patterns of medication use from currently available structured datasets
and the use of natural language processing (NLP) to identify the CVD patients not on a guideline concordant
statin therapy due to statin intolerance or provider clinical inertia. We will also perform a pilot study providing
succinct information to patient aligned care teams (PACTs) in the form of a point-of-care communication aid
which targets these gaps. Aim 1: To identify reasons (allergy, intolerance, or clinical inertia) Veterans with
CVD are not receiving guideline-recommended statin therapy based on structured data and automated
information extraction with NLP. Aim 2: To understand provider and patient understanding of statin intolerance
and to describe providers' lipid management strategies addressing intolerance through qualitative interviews.
Based on these interviews, we will refine a succinct communication aid targeted towards PACT providers
which will allow them to effectively initiate and/or titrate statins to evidence-based doses in CVD patients
(including patients who are intolerant to statins). Aim 3: To pilot test a communication aid in Houston and
Nashville VA PACTs to determine whether its use is associated with an increase in guideline-concordant statin
therapy use in patients with CVD compared to usual care.
Methods: For Aim 1, we will randomly identify CVD patients from throughout the VA system (500 on optimal
statins, 500 on statin but on less than moderate-intensity dose, and 500 not on a statin) and randomly partition
them into training and a test set. We will then train our NLP system to achieve a sensitivity and specificity of
>90%, compared with manual chart review. In Aim 2, we will conduct qualitative interviews with providers and
patients in VISN 16 to elicit their perspectives on clinical inertia and intolerance related to statins. These
interviews will help facilitate the refinement of the content of the communication aid for use during the pilot
ph...

## Key facts

- **NIH application ID:** 9979653
- **Project number:** 5I01HX002225-03
- **Recipient organization:** MICHAEL E DEBAKEY VA MEDICAL CENTER
- **Principal Investigator:** Salim S Virani
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-07-01 → 2021-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9979653

## Citation

> US National Institutes of Health, RePORTER application 9979653, Determining and targeting reasons for low statin use to improve guideline-concordant statin therapy in high-risk patients (5I01HX002225-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9979653. Licensed CC0.

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