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Statin Eligibility and Outpatient Care Prior to ST-Segment Elevation Myocardial Infarction
Michael D Miedema1,2, Ross F Garberich3, Lucas J Schnaidt3
1Minneapolis Heart Institute Foundation, Minneapolis, MN mdm307@mail.harvard.edu.
Insights
The 2013 cholesterol guidelines significantly increased statin eligibility for heart attack patients compared to older guidelines. However, suboptimal healthcare access limited guideline implementation before myocardial infarction.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- The 2013 American College of Cardiology/American Heart Association cholesterol guidelines aimed to improve cardiovascular disease (CVD) prevention.
- The impact of these guidelines on statin eligibility for individuals at risk of CVD events remains unclear.
Purpose of the Study:
- To evaluate the effect of the 2013 ACC/AHA cholesterol guidelines on pre-event statin eligibility in ST-segment elevation myocardial infarction (STEMI) patients.
- To compare statin eligibility under the 2013 ACC/AHA guidelines versus the prior ATP III guidelines.
Main Methods:
- Analysis of a prospective cohort of 1062 STEMI patients.
- Assessment of pre-STEMI statin eligibility using both 2013 ACC/AHA and ATP III guidelines.
- Review of patient demographics, lipid levels, CVD risk factors, and healthcare utilization in the two years prior to STEMI.
Main Results:
- Under the 2013 ACC/AHA guidelines, 79.0% of patients would have been eligible for statin therapy, compared to 38.7% under ATP III guidelines.
- Only 62.5% of patients with prior CVD and 19.3% without prior CVD were on statin therapy before STEMI.
- Less than half of patients had seen a primary care provider in the two years preceding their STEMI.
Conclusions:
- The 2013 ACC/AHA cholesterol guidelines substantially increase potential statin eligibility in STEMI patients.
- Despite expanded eligibility, suboptimal healthcare access and utilization prior to STEMI hinder effective guideline implementation and preventive care.
Background:
The impact of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines on statin eligibility in individuals otherwise destined to experience cardiovascular disease (CVD) events is unclear.
Methods And Results:
We analyzed a prospective cohort of consecutive ST-segment elevation myocardial infarction (STEMI) patients from a regional STEMI system with data on patient demographics, low-density lipoprotein cholesterol levels, CVD risk factors, medication use, and outpatient visits over the 2 years prior to STEMI. We determined pre-STEMI eligibility according to American College of Cardiology/American Heart Association guidelines and the prior Third Report of the Adult Treatment Panel guidelines. Our sample included 1062 patients with a mean age of 63.7 (13.0) years (72.5% male), and 761 (71.7%) did not have known CVD prior to STEMI. Only 62.5% and 19.3% of individuals with and without prior CVD were taking a statin before STEMI, respectively. In individuals not taking a statin, median (interquartile range) low-density lipoprotein cholesterol levels in those with and without known CVD were low (108 [83, 138] mg/dL and 110 [87, 133] mg/dL). For individuals not taking a statin, only 38.7% were statin eligible by ATP III guidelines. Conversely, 79.0% would have been statin eligible according to American College of Cardiology/American Heart Association guidelines. Less than half of individuals with (49.2%) and without (41.1%) prior CVD had seen a primary care provider during the 2 years prior to STEMI.
Conclusions:
In a large cohort of STEMI patients, application of American College of Cardiology/American Heart Association guidelines more than doubled pre-STEMI statin eligibility compared with Third Report of the Adult Treatment Panel guidelines. However, access to and utilization of health care, a necessity for guideline implementation, was suboptimal prior to STEMI.