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

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.

• Authors: 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
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 65 Issue 3 Pg. 270-7 (Jan 27 2015) ISSN: 1558-3597 [Electronic] United States
• PMID: 25614424 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Hydroxymethylglutaryl-CoA Reductase Inhibitors

Topics

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