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In-hospital initiation of lipid-lowering therapy after coronary intervention as a predictor of long-term utilization:
Herbert D Aronow1, Gian M Novaro, Michael S Lauer
1Division of Cardiovascular Medicine, Department of Internal Medicine, University of Pennsylvania Medical Center and Philadelphia Veterans Administration Medical Center, Philadelphia, PA, USA.
Insights
Initiating lipid-lowering therapy before hospital discharge significantly increases long-term use for secondary coronary disease prevention. Patients starting therapy in-hospital are nearly three times more likely to continue it six months later.
Area of Science:
- Cardiovascular Medicine
- Pharmacotherapy
- Health Services Research
Background:
- Lipid-lowering agents are crucial for secondary coronary disease prevention but are underused.
- Few studies have investigated the impact of predischarge therapy initiation on long-term adherence.
Purpose of the Study:
- To examine the association between inpatient initiation of lipid-lowering therapy and its long-term use.
- To identify strategies for improving adherence to lipid-lowering medications.
Main Methods:
- Retrospective propensity-analyzed cohort study using data from the EPILOG trial (n=2126).
- Patients undergoing percutaneous coronary intervention were analyzed based on whether they received lipid-lowering therapy before discharge.
- Propensity matching was used to control for confounding factors.
Main Results:
- Patients initiated on lipid-lowering therapy before discharge had a 3.17-fold higher likelihood of continuing therapy at 6 months (77% vs. 25%).
- In propensity-matched analysis, inpatient initiation was the strongest independent predictor of 6-month use (RR, 2.50).
Conclusions:
- Inpatient initiation of lipid-lowering therapy is a strong predictor of sustained use.
- This strategy effectively bridges the gap between evidence-based guidelines and clinical practice for secondary prevention of coronary disease.
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.
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