Statin Utilization Patterns and Outcomes for Patients with Acute Coronary Syndrome During and Following Inpatient
Susan H Boklage1, Elisabetta Malangone-Monaco2, Lorena Lopez-Gonzalez2
1Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd., Tarrytown, NY, 10591, USA. susan.boklage@regeneron.com.
Insights
High-intensity statin (HIS) use after acute coronary syndrome (ACS) is lower than recommended. This underutilization increases patient risk for cardiovascular events and healthcare costs.
Area of Science:
- Cardiology
- Health Economics
- Public Health
Background:
- Current guidelines recommend high-intensity statins (HIS) for atherosclerotic cardiovascular disease, especially post-acute coronary syndrome (ACS).
- Adherence to these guidelines for statin therapy remains suboptimal.
- Understanding statin utilization patterns and their impact is crucial for improving patient outcomes.
Purpose of the Study:
- To describe statin utilization patterns during hospitalization and the year following an acute coronary syndrome (ACS) event.
- To evaluate the association between statin utilization and subsequent clinical and economic outcomes.
- To assess adherence to high-intensity statin (HIS) recommendations post-ACS.
Main Methods:
- Retrospective observational study using US MarketScan Research Databases (2002-2014).
- Included adults with at least one inpatient admission for ACS and no prior ACS event within 12 months.
- Analyzed statin prescription fills, timing of prescriptions, and post-discharge cardiovascular events and costs.
Main Results:
- Statin utilization, particularly high-intensity statins (HIS), increased from pre-ACS admission to index hospitalization and follow-up, but remained below guideline recommendations.
- Among patients discharged with a statin, 53.2% filled prescriptions within 15 days, while 14.9% delayed over 91 days.
- Increased rates of recurrent ACS, heart failure, and revascularization were observed, alongside significant all-cause and cardiovascular-specific hospital admissions and associated healthcare costs.
Conclusions:
- Statin dosing and high-intensity statin (HIS) utilization fall short of current treatment guidelines for ACS patients.
- Suboptimal statin use places patients at significant risk for recurrent cardiovascular events.
- There is a critical need to improve adherence to HIS recommendations to mitigate post-ACS cardiovascular risk and associated healthcare expenditures.
Purpose:
High-intensity statins (HIS) are recommended by current treatment guidelines for patients with clinical atherosclerotic cardiovascular disease and should be administered soon after an acute coronary syndrome (ACS) event and maintained thereafter. However, adherence to guidelines remains adequate. Statin utilization patterns during index hospitalization and the first year after ACS event, and the association between statin utilization and post-discharge clinical and economic outcomes, are described.
Methods:
Retrospective, observational study of US adults from the MarketScan Research Databases (2002-2014) with ≥ 1 inpatient admission for ACS and no evidence of previous ACS event < 12 months prior to index.
Results:
In total, 7802 patients met inclusion criteria. The most common index hospitalization primary diagnosis was myocardial infarction (94.6%). In the 3-month period before ACS admission, 3.4 and 14.9% of patients received HIS or low-to-moderate intensity statin, versus 13.2 and 30.7% during index hospitalization, and 16.4 and 45.1% in the year of follow-up. Of 1336 patients with a statin prescription filled on/after discharge, 53.2% filled prescriptions within 15 days of discharge and 14.9% delayed for > 91 days. The most common post-index hospital admissions for cardiovascular events were due to recurrent ACS (incidence rate = 115.2), heart failure (110.0), and revascularization (76.4). During follow-up, 2355 patients (30.2%) had all-cause inpatient admissions and 1136 (14.6%) had cardiovascular-specific admissions; mean all-cause medical and healthcare costs were $2456 and $2870, respectively, per patient per month.
Conclusions:
Statin dosing and utilization of HIS remains lower than recommended in current treatment guidelines, leaving patients at considerable risk of subsequent cardiovascular events.
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