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

Robert S Rosenson1, Shia T Kent2, Todd M Brown3

  • 1Icahn School of Medicine at Mount Sinai, New York, New York.

Journal of the American College of Cardiology
|January 24, 2015
PubMed

Insights

Most Medicare beneficiaries do not receive high-intensity statins after hospitalization for coronary heart disease (CHD). Prior statin use significantly influences post-discharge prescription intensity, with many patients not transitioning to optimal therapy.

Area of Science:

  • Cardiology
  • Pharmacology
  • Health Services Research

Background:

  • National guidelines advocate for high-intensity statin use following coronary heart disease (CHD) events.
  • Adherence to these guidelines is crucial for secondary prevention in patients with CHD.

Purpose of the Study:

  • To determine the proportion of Medicare beneficiaries prescribed high-intensity statins post-hospitalization for CHD.
  • To investigate the association between pre-hospitalization statin intensity and post-discharge statin intensity.

Main Methods:

  • Retrospective cohort study of Medicare beneficiaries aged 65-74.
  • Analysis of prescription data for beneficiaries hospitalized for myocardial infarction or coronary revascularization between 2007-2009.
  • Defined high-intensity statins as specific dosages of atorvastatin, rosuvastatin, and simvastatin.

Main Results:

  • Only 27% of beneficiaries had their first post-discharge statin fill for a high-intensity medication.
  • Pre-hospitalization high-intensity statin use was strongly associated with post-discharge high-intensity statin use (RR 4.01).
  • Beneficiaries on low/moderate-intensity statins pre-hospitalization were less likely to receive high-intensity statins post-discharge (RR 0.45).

Conclusions:

  • A significant majority of Medicare beneficiaries do not fill high-intensity statins after CHD hospitalization.
  • Pre-existing statin regimen is a key determinant of post-discharge therapy intensity.
  • Interventions may be needed to improve guideline adherence for high-intensity statin use in this population.
Abstract

Keywords:
coronary artery diseasedrug usehydroxymethylglutaryl-CoA reductase inhibitorssecondary prevention

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