Hurwitz, H.

Background Statin Choice is a shared decision-making encounter tool embedded in the electronic health record. Objective To describe the association between the use of Statin Choice, statin prescriptions by clinicians, prescription fills (primary adherence), and statin adherence at 12 mo (secondary adherence). Design Observational cohort study at the Cleveland Clinic Health System. Subjects Statin-naïve adults aged 40 to 75 y with a 10-y atherosclerotic cardiovascular disease (ASCVD) risk of ≥5% and a primary care appointment between January 2020 and July 2021. Main Measures The primary exposure was the use of Statin Choice during a clinical encounter. We measured whether the use of Statin Choice was associated with statin prescriptions. We measured statin adherence based on pharmacy fill data at 60 d (primary adherence) and 12 mo (secondary adherence). We used mixed-effects logistic regression to estimate the adjusted odds of statin prescriptions and adherence at the 3 time points by the use of Statin Choice. Key Results Among 17,001 statin-naïve patients, 13% viewed Statin Choice and 7% were prescribed a statin. The median ASCVD risk was 10%. Patients who were shown Statin Choice had 9.04 higher odds of being prescribed a statin compared with patients not shown Statin Choice (95% confidence interval [CI]: 7.86–10.4). Among patients prescribed a statin, the use of Statin Choice was associated with 5.75 higher odds of primary adherence compared with usual care (95% CI: 4.22–7.83). At 12 mo, Statin Choice use was significantly associated with adherence in the unadjusted analysis (OR: 1.58; 95% CI: 1.05–2.08) but was not significant after adjustment for patient factors. Patients shown Statin Choice had an average of 12 mg/dL reduction in low-density lipoprotein cholesterol at 12 mo (95% CI: −16 mg/dL, −10) compared with those not shown Statin Choice. Conclusion In this observational study, Statin Choice use was strongly associated with statin prescription and fills and weakly associated with adherence to statins for up to 1 y. A randomized trial is needed to confirm causality. Highlights Statin Choice is an electronic health record–embedded shared decision-making encounter tool available for free in many health care systems. Small randomized controlled trials have found modest associations between the use of Statin Choice and statin adherence using patient-reported data. In our large study using pharmacy fill data, clinician use of Statin Choice during a medical encounter was associated with significantly greater patient adherence with statins up to 1 y later. Exposure to Statin Choice was associated with a significant reduction in low-density lipoprotein cholesterol over 1 y.

480 Background: COs associated with varying Tx patterns in mCRC pts are poorly understood because patterns diverge from the randomized trials (RCT). The RCTs of BV (Avastin) plus chemotherapy (CT) in mCRC pts continued BV until progressive disease (PD), even if CT was stopped/changed. Some RCTs of BV+CT in mCRC show ∼50% of pts stopping Tx early for reasons other than PD with possible lessening of benefit. It is unclear if this is due to use of a particular CT regimen or other practice pattern. While the beneficial effect of post-PD BV Tx has been shown in ARIES (HR 0.52 BBP vs No BBP) [A Cohn, ASCO 2010], the effect of stopping BV or CT before PD is unclear. ARIES, a community based observational study with a large cohort of 1st line BV-treated mCRC pts, will assess the COs associated with different 1st line Tx patterns (BV and CT) based on real world practice. Methods: ARIES enrolled mCRC pts receiving first- or second-line CT+BV. No Tx regimens or assessments are protocol specified. Data are collected prospectively at baseline (BL) and quarterly. Analyses included first-line pts with PD. Tx patterns of pts initially treated with FOLFOX/BV or FOLFIRI/BV are described and preliminary COs (PFS and OS) are estimated from K-M curves. Tx duration is calculated from enrollment date. Results: As of 2/5/10, 1,548 first-line mCRC pts enrolled (median follow up = 21 m); 1,133 pts had PD. Of 1,133 pts with PD, most had FOLFOX/BV (63%) or FOLFIRI/BV (16%) as first CT. BL characteristics were similar, but the FOLFOX/BV group had more stage 4 pts (74%). Main reasons for stopping BV include AE, max benefit achieved and CT holiday. Tx patterns and COs are in the table. Conclusions: ARIES first-line mCRC pts treated with FOLFOX/BV or FOLFIRI/BV had similar Tx patterns and COs despite the common opinion that they may differ in tolerability and possibly effectiveness. Additional analyses will assess the impact of stopping BV and/or CT before PD. [Table: see text] [Table: see text]