In-hospital initiation of lipid-lowering therapy after coronary intervention as a predictor of long-term utilization: a propensity analysis.

Abstract

BACKGROUND:

Despite multiple randomized trials demonstrating their efficacy for the secondary prevention of coronary disease, lipid-lowering agents remain underused. Few studies have examined the relationship between predischarge initiation of lipid-lowering therapy and long-term use.

METHODS:

Using data from patients at 69 centers from the United States and Canada enrolled in the Evaluation in PTCA to Improve Long-term Outcome With Abciximab GP IIb/IIIa Blockade (EPILOG) trial, we performed a retrospective propensity-analyzed cohort study. Patients underwent percutaneous coronary intervention for stable or recently unstable coronary disease and were older than 21 years, were not taking lipid-lowering therapy at the time of admission, and survived to hospital discharge; 175 were discharged taking lipid-lowering therapy and 1951 were not.

RESULTS:

After 6 months, 77% of patients who started taking lipid-lowering agents before hospital discharge continued taking therapy, compared with only 25% of those discharged without these agents (relative risk, 3.17; 95% confidence interval, 2.88-3.41; P<.001). After restricting the analysis to propensity-matched patients (n = 477) and adjusting for other potential confounders, initiation of a lipid-lowering agent during hospitalization was the strongest independent predictor of use at 6 months (relative risk, 2.50; 95% confidence interval, 2.29-2.65; P<.001).

CONCLUSIONS:

Inpatient initiation of lipid-lowering therapy is a strong and independent positive predictor of subsequent use, with patients who start taking lipid-lowering therapy before hospital discharge nearly 3 times as likely to be taking these agents 6 months later. Inpatient initiation of lipid-lowering therapy appears to be an effective strategy for bridging the gap between current medical knowledge and practice.

• Authors: Herbert D Aronow, Gian M Novaro, Michael S Lauer, Danielle M Brennan, A Michael Lincoff, Eric J Topol, Dean J Kereiakes, Steven E Nissen
• Journal: Archives of internal medicine (Arch Intern Med) Vol. 163 Issue 21 Pg. 2576-82 (Nov 24 2003) ISSN: 0003-9926 [Print] United States
• PMID: 14638557 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Hypolipidemic Agents
• Immunoglobulin Fab Fragments
• Platelet Aggregation Inhibitors
• Abciximab

Topics

• Abciximab
• Aged
• Angioplasty, Balloon, Coronary
• Antibodies, Monoclonal (therapeutic use)
• Coronary Disease (prevention & control)
• Drug Utilization
• Female
• Hospitalization
• Humans
• Hypolipidemic Agents (therapeutic use)
• Immunoglobulin Fab Fragments (therapeutic use)
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Platelet Aggregation Inhibitors (therapeutic use)