Objectives

To describe treatment patterns of patients with ASCVD and hypercholesterolemia in Canada using novel NLP technology. Canadian lipid guidelines (GL) were recently (2021) updated, hence we also sought to understand how the change in LDL-C threshold will impact the current treatment gap.

Methods

Electronic medical records (EMRs) of patients (n=9415) with ASCVD and with >1 physician visit between June 2016 to November 2019 with >1 year of follow up were queried using NLP of structured and unstructured data to extract variables of interest. Extraction of patient files occurred in cardiology (95% of patients) and general internal medicine (5% of patients) practices (n=53) across 4 Canadian provinces. Definitions of uncontrolled LDL-C were ≥2.0 mmol/L (2016 GL) or ≥1.8 mmol/L (2021 GL).

Results

Over 50% of patients (5139; 54.6%) had an LDL-C measure at baseline. 38% (1953) of patients were uncontrolled as per 2016 GL; this rose to 47% (2437) using 2021 GL. At baseline among those with uncontrolled LDL-C (n=1953, 2016 GL), 33% had no documented LLT use, 49% had statin monotherapy, and 11% had statin+ezetimibe combination. More than 55% of patients with uncontrolled LDL-C had no treatment modifications during follow-up. Treatment modifications were as follows: addition/switching of statins (43%), ezetimibe (33%) and PCSK9i (9%). Mean LDL-C % decrease: statin (-31%), ezetimibe (-39%) and PCSK9i (-55%). Despite changes in LLT, LDL-C remained above 2016 GL target in 43% of patients.

Conclusions

NLP was an effective method to efficiently assess current treatment patterns of patients with ASCVD and hypercholesterolemia. Recent changes in Canadian GL LDL-C thresholds will lead to a larger treatment gap (i.e., more patients whose LDL-C level signals a call for LLT intensification) and worse health outcomes unless prompt clinical action is taken to optimize LLT in this population.