Association between frequency of primary care provider visits and evidence-based statin prescribing and statin adherence: Findings from the Veterans Affairs system

Sarah T. Ahmed, Dhruv Mahtta, Hasan Rehman, Julia Akeroyd, Mahmoud Al Rifai, Fatima Rodriguez, Hani Jneid, Khurram Nasir, Zainab Samad, Mahboob Alam, Laura A. Petersen, Salim S. Virani

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


BACKGROUND: Statin use remains suboptimal in patients with atherosclerotic cardiovascular disease (ASCVD). We assessed if the frequency of visits with primary care providers (PCPs) is associated with higher use of evidence-based statin prescriptions and adherence among patients with ASCVD.

METHODS: We identified patients with ASCVD aged ≥18 years receiving care in 130 facilities and associated community-based outpatient clinics in the entire Veterans Affairs Health Care System between October 1, 2013 and September 30, 2014. Patients were divided into frequent PCP visitors (annual PCP visits ≥ median number of PCP visits for the entire cohort) and infrequent PCP visitors (annual PCP visits < median number of patient visits). We assessed any- and high-intensity statin prescription as well as statin adherence which was defined by proportion of days covered (PDC).

RESULTS: We included 1,249,061 patients with ASCVD (mean age was 71.9 years; 98.0% male). Median number of annual PCP visits was 3. Approximately 80.1% patients were on statins with 23.8% on high-intensity statins. Mean PDC was 0.715 ± 0.336 with 58.3% patients with PDC ≥0.8. Frequent PCP visitors had higher frequency of statin use (82.2% vs 77.4%), high-intensity statin use (26.4% vs 20.3%), and statin adherence (mean PDC 0.73 vs 0.68; P < .01) compared to infrequent PCP visitors. After adjusting for covariates, frequent PCP visits was associated with greater odds of being on any statin, high intensity statin, and higher statin adherence.

CONCLUSION: Frequent visits with PCPs is associated with a higher likelihood of any statin use, high intensity statin use, and statin adherence. Further research endeavors are needed to understand the reasons behind these associations.

Original languageEnglish (US)
Pages (from-to)9-18
Number of pages10
JournalAmerican Heart Journal
StatePublished - Mar 2020


  • Aged
  • Aged, 80 and over
  • Appointments and Schedules
  • Atherosclerosis/drug therapy
  • Female
  • Guideline Adherence
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
  • Male
  • Medication Adherence/statistics & numerical data
  • Middle Aged
  • Physicians, Primary Care
  • Practice Patterns, Physicians'/statistics & numerical data
  • Primary Health Care/statistics & numerical data
  • United States
  • United States Department of Veterans Affairs

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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