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Background:Despite their effectiveness in reducing low-density lipoprotein-cholesterol (LDL-C) and cardiovascular disease (CVD) risk, high-intensity statins are underutilized among patients with LDL-C ≥ 190 mg/dL. We aimed to determine if a patient outreach program (KP Sure Net) automating high-intensity statin orders and lipid panels improved statin initiation and lab completions.Methods:Kaiser Permanente Southern California adults 20-60 years of age with LDL-C ≥ 190 mg/dL and no recent statin use were compared pre- (January 2016-September 2018, n=3,534) and post- (April 2019-July 2021, n=3,555) program implementation to examine statin prescriptions and fills, lab completions, and improved LDL-C (<190 mg/dL) at 6 months. Using Poisson regression with robust variance, we calculated relative risks (RR) and 95% confidence intervals (CI) for the association of program implementation with statin prescriptions, fills, lab completions, and improved LDL-C, separately, adjusting for sociodemographics, insurance, comorbidity burden, and non-statin medication use.Results:Among adults identified during pre- and post-implementation, 759 (21.5%) and 976 (27.5%), respectively, received a statin prescription. Adults with a prescription post- versus pre-implementation were more likely to be younger, identify as Black or Asian ethnicity, be English-speaking and have higher income, but were similar by sex, education, insurance, and comorbidity burden. (Table) After multivariable adjustment, adults post- versus pre-implementation had a higher likelihood of receiving a statin prescription (RR 1.36, 95% CI 1.25, 1.48), filling their statin (RR 1.32, 95% CI 1.26, 1.38), completing their lipid panel (RR 1.60, 95% CI 1.44, 1.78), and improving LDL-C (RR 1.36, 95% CI 1.20, 1.53).Conclusion:Automating statin orders and lipid panels for high-risk adults improved prescription rates, fills and LDL-C. Understanding facilitators and barriers to adherence is an important next step in improving patients’ health.

Introduction:Sex differences in comorbidities and care received during hospitalization for acute myocardial infarction (AMI) may lead to disparities in short-term outcomes following discharge. We examined the association between sex and 30-day all-cause mortality among adults hospitalized with AMI in a diverse, integrated healthcare delivery system.Methods:We identified 44,142 Kaiser Permanente Southern California members (aged >35 years) with a primary discharge diagnosis of AMI between 2000 and 2014. Incident AMI hospitalization was defined as the first AMI event identified in the electronic health record between 2000 and 2014, with no prior AMI hospitalizations. Death was ascertained from administrative sources, state death data, and Social Security Administration files. We compared characteristics of women and men hospitalized for AMI and estimate relative risks (RR) and 95% confidence intervals (CI) for the association between sex and 30-day all-cause mortality.Results:Women were older and more likely to be black, more likely to have hypertension and chronic obstructive pulmonary disease, and less likely to receive coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) during AMI hospitalization compared to men. (Table) Overall, 12.0% of women and 8.9% of men died within 30 days of discharge. After adjustment for age, race, and year of hospitalization women compared to men had an increased likelihood of 30-day mortality (RR 1.08, 95% CI 1.02, 1.14). The addition of comorbidities and AMI type did not change this association (RR 1.09, 95% CI 1.03, 1.15). After additional adjustment for CABG and PCI, men and women had an equal likelihood of 30-day mortality (RR 1.04, 95% CI 0.98, 1.10).Conclusion:Women compared to men had a higher likelihood of 30-day mortality independent of sociodemographic and clinical characteristics. This disparity may be attributable to differences in in-hospital care.