Underutilization of High-Intensity Statin Therapy After Hospitalization for Coronary Heart Disease

作者：Rosenson Robert S^*; Kent Shia T; Brown Todd M; Farkouh Michael E; Levitan Emily B; Yun Huifeng; Sharma Pradeep; Safford Monika M; Kilgore Meredith; Muntner Paul; Bittner Vera

来源：Journal of the American College of Cardiology, 2015, 65(3): 270-277.

DOI：10.1016/j.jacc.2014.09.088

• coronary artery disease
• drug use
• hydroxymethylglutaryl-CoA reductase inhibitors
• secondary prevention

BACKGROUND National guidelines recommend use of high-intensity statins after hospitalization for coronary heart disease (CHD) events.
OBJECTIVES This study sought to estimate the proportion of Medicare beneficiaries filling prescriptions for high-intensity statins after hospital discharge for a CHD event and to analyze whether statin intensity before hospitalization is associated with statin intensity after discharge.
METHODS We conducted a retrospective cohort study using a 5% random sample of Medicare beneficiaries between 65 and 74 years old. Beneficiaries were included in the analysis if they filled a statin prescription after a CHD event (myocardial infarction or coronary revascularization) in 2007, 2008, or 2009. High-intensity statins included atorvastatin 40 to 80 mg, rosuvastatin 20 to 40 mg, and simvastatin 80 mg.
RESULTS Among 8,762 Medicare beneficiaries filling a statin prescription after a CHD event, 27% of first post-discharge fills were for a high-intensity statin. The percent filling a high-intensity statin post-discharge was 23.1%, 9.4%, and 80.7%, for beneficiaries not taking statins pre-hospitalization, taking low/moderate-intensity statins, and taking high-intensity statins before their CHD event, respectively. Compared with beneficiaries not on statin therapy pre-hospitalization, multivariable adjusted risk ratios for filling a high-intensity statin were 4.01 (3.58-4.49) and 0.45 (0.40-0.52) for participants taking high-intensity and low/moderate-intensity statins before their CHD event, respectively. Only 11.5% of beneficiaries whose first post-discharge statin fill was for a low/moderate-intensity statin filled a high-intensity statin within 365 days of discharge.
CONCLUSIONS The majority of Medicare beneficiaries do not fill high-intensity statins after hospitalization for CHD.

• 出版日期2015-1-27