Trends in Use of High-Intensity Statin Therapy After Myocardial Infarction, 2011 to 2014
Robert S Rosenson1, Michael E Farkouh2, Matthew Mefford3
1Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York.
Insights
High-intensity statin use after myocardial infarction discharge significantly increased from 2011 to 2014. This trend was observed across different insurance types and patient groups, indicating improved post-MI treatment.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Health Services Research
Background:
- Prior to 2011, low rates of high-intensity statin prescriptions were noted for acute coronary syndrome patients upon discharge.
- Factors like black-box warnings, generic atorvastatin availability, and updated guidelines may have influenced statin prescribing patterns.
Purpose of the Study:
- To analyze trends in high-intensity statin use after hospital discharge for myocardial infarction (MI) between 2011 and 2014.
- To identify predictors of high-intensity statin use in MI patients post-discharge.
Main Methods:
- Analysis of secular trends in high-intensity statin use among MI patients aged 19-64 (MarketScan) and 66-75 (Medicare) from 2011-2014.
- Inclusion criteria: patients filling statin prescriptions within 30 days of discharge. High-intensity statins defined as atorvastatin 40/80 mg or rosuvastatin 20/40 mg.
Main Results:
- High-intensity statin use increased from 33.5% to 71.7% (MarketScan) and 24.8% to 57.5% (Medicare) between 2011 and 2014.
- Increases observed in both new statin initiators and patients switching from lower-intensity statins.
- In 2014, male sex, co-prescription of beta-blockers/antiplatelets, and cardiac rehabilitation were associated with high-intensity statin use.
Conclusions:
- High-intensity statin use following myocardial infarction hospitalization showed a progressive increase from 2011 to 2014.
- These findings suggest a positive shift in guideline-adherent lipid-lowering therapy post-MI.
Background:
Data prior to 2011 suggest that a low percentage of patients hospitalized for acute coronary syndromes filled high-intensity statin prescriptions upon discharge. Black-box warnings, generic availability of atorvastatin, and updated guidelines may have resulted in a change in high-intensity statin use.
Objectives:
The aim of this study was to examine trends and predictors of high-intensity statin use following hospital discharge for myocardial infarction (MI) between 2011 and 2014.
Methods:
Secular trends in high-intensity statin use following hospital discharge for MI were analyzed among patients 19 to 64 years of age with commercial health insurance in the MarketScan database (n = 42,893) and 66 to 75 years of age with U.S. government health insurance through Medicare (n = 75,096). Patients filling statin prescriptions within 30 days of discharge were included. High-intensity statins included atorvastatin 40 or 80 mg and rosuvastatin 20 or 40 mg.
Results:
The percentage of beneficiaries whose first statin prescriptions filled following hospital discharge for MI were for high-intensity doses increased from 33.5% in January through March 2011 to 71.7% in October through November 2014 in MarketScan and from 24.8% to 57.5% in Medicare. Increases in high-intensity statin use following hospital discharge occurred over this period among patients initiating treatment (30.6% to 72.0% in MarketScan and 21.1% to 58.8% in Medicare) and those taking low- or moderate-intensity statins prior to hospitalization (from 27.8% to 62.3% in MarketScan and from 12.6% to 45.1% in Medicare). In 2014, factors associated with filling high-intensity statin prescriptions included male sex, filling beta-blocker and antiplatelet agent prescriptions, and attending cardiac rehabilitation within 30 days following discharge.
Conclusions:
The use of high-intensity statins following hospitalization for MI increased progressively from 2011 through 2014.
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