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

被引：154

作者：

Rosenson, Robert S. ^{[1
]}

Kent, Shia T. ^{[2
]}

Brown, Todd M. ^{[3
]}

Farkouh, Michael E. ^{[1
,5
]}

Levitan, Emily B. ^{[2
]}

Yun, Huifeng ^{[2
]}

Sharma, Pradeep ^{[2
]}

Safford, Monika M. ^{[3
]}

Kilgore, Meredith ^{[4
]}

Muntner, Paul ^{[2
]}

Bittner, Vera ^{[3
]}

机构：

[1] Icahn Sch Med Mt Sinai, New York, NY 10029 USA

[2] Univ Alabama Birmingham, Dept Epidemiol, Birmingham, AL USA

[3] Univ Alabama Birmingham, Dept Med, Birmingham, AL 35294 USA

[4] Univ Alabama Birmingham, Dept Healthcare Org & Policy, Birmingham, AL USA

[5] Univ Toronto, Div Cardiol, Toronto, ON, Canada

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2015年 / 65卷 / 03期

关键词：

coronary artery disease; drug use; hydroxymethylglutaryl-CoA reductase inhibitors; secondary prevention; ACUTE MYOCARDIAL-INFARCTION; MEDICATION RECONCILIATION; ADMINISTRATIVE DATA; ATORVASTATIN; EVENTS; CARE; REDUCTION; INPATIENT; DISCHARGE; EFFICACY;

D O I：

10.1016/j.jacc.2014.09.088

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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. (C) 2015 by the American College of Cardiology Foundation.

引用

页码：270 / 277

页数：8

共 29 条

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