Underutilization of high-intensity statin therapy after hospitalization for coronary heart disease

Robert S Rosenson; Shia T Kent; Todd M Brown; Michael E Farkouh; Emily B Levitan; Huifeng Yun; Pradeep Sharma; Monika M Safford; Meredith Kilgore; Paul Muntner; Vera Bittner

doi:10.1016/j.jacc.2014.09.088

Underutilization of high-intensity statin therapy after hospitalization for coronary heart disease

J Am Coll Cardiol. 2015 Jan 27;65(3):270-7. doi: 10.1016/j.jacc.2014.09.088.

Authors

Affiliations

¹ Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: robert.rosenson@mssm.edu.
² Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
³ Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
⁴ Icahn School of Medicine at Mount Sinai, New York, New York; Division of Cardiology, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Healthcare Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama.

PMID: 25614424
DOI: 10.1016/j.jacc.2014.09.088

Abstract

Background: National guidelines recommend use of high-intensity statins after hospitalization for coronary heart disease (CHD) events.

Objectives: This study sought to estimate the proportion of Medicare beneficiaries filling prescriptions for high-intensity statins after hospital discharge for a CHD event and to analyze whether statin intensity before hospitalization is associated with statin intensity after discharge.

Methods: We conducted a retrospective cohort study using a 5% random sample of Medicare beneficiaries between 65 and 74 years old. Beneficiaries were included in the analysis if they filled a statin prescription after a CHD event (myocardial infarction or coronary revascularization) in 2007, 2008, or 2009. High-intensity statins included atorvastatin 40 to 80 mg, rosuvastatin 20 to 40 mg, and simvastatin 80 mg.

Results: Among 8,762 Medicare beneficiaries filling a statin prescription after a CHD event, 27% of first post-discharge fills were for a high-intensity statin. The percent filling a high-intensity statin post-discharge was 23.1%, 9.4%, and 80.7%, for beneficiaries not taking statins pre-hospitalization, taking low/moderate-intensity statins, and taking high-intensity statins before their CHD event, respectively. Compared with beneficiaries not on statin therapy pre-hospitalization, multivariable adjusted risk ratios for filling a high-intensity statin were 4.01 (3.58-4.49) and 0.45 (0.40-0.52) for participants taking high-intensity and low/moderate-intensity statins before their CHD event, respectively. Only 11.5% of beneficiaries whose first post-discharge statin fill was for a low/moderate-intensity statin filled a high-intensity statin within 365 days of discharge.

Conclusions: The majority of Medicare beneficiaries do not fill high-intensity statins after hospitalization for CHD.

Keywords: coronary artery disease; drug use; hydroxymethylglutaryl-CoA reductase inhibitors; secondary prevention.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cohort Studies
Coronary Artery Bypass
Coronary Disease / drug therapy*
Coronary Disease / epidemiology
Dose-Response Relationship, Drug
Drug Prescriptions / statistics & numerical data*
Female
Hospitalization
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*
Male
Medicare
Myocardial Infarction / epidemiology
Myocardial Infarction / prevention & control
Patient Discharge*
Percutaneous Coronary Intervention
Retrospective Studies
Secondary Prevention*
United States / epidemiology

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors