What question did this study set out to answer?

To estimate how many Medicare patients continue taking high-intensity statins with high adherence after myocardial infarction and identify related factors.

April 19, 2017JAMA Cardiology

Adherence to High-Intensity Statins Following a Myocardial Infarction Hospitalization Among Medicare Beneficiaries

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To estimate how many Medicare patients continue taking high-intensity statins with high adherence after myocardial infarction and identify related factors.
Retrospective cohort study of Medicare beneficiaries hospitalized for myocardial infarction from 2007 to 2012.
Population included patients aged 66 to 75 years and older than 75 years, focusing on those filling high-intensity statin prescriptions within 30 days of discharge.
High adherence defined by at least 80% of days covered in statin use at 6 months and 2 years post-discharge.
At 6 months, 58.9% of beneficiaries aged 66-75 years had high adherence; by 2 years, this dropped to 41.6%.
8.7% and 13.4% of beneficiaries down-titrated to lower-intensity statins at 6 months and 2 years respectively.
New high-intensity statin users and those with dual Medicare/Medicaid coverage were less likely to maintain high adherence.

Structured PICO

Population

57,898 Medicare beneficiaries aged ≥66 years (n=29,932 aged 66-75 years; n=27,956 older than 75 years) hospitalized for myocardial infarction between 2007 and 2012 who filled a high-intensity statin prescription within 30 days of discharge. Approximately half were women and four-fifths were white.

Intervention

High-intensity statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg) filled within 30 days of hospital discharge

Outcome

High adherence to high-intensity statins at 6 months and 2 years after discharge (defined by a proportion of days covered of at least 80%)

A substantial proportion of Medicare beneficiaries do not maintain high adherence to high-intensity statins 2 years after a myocardial infarction, highlighting a significant gap in secondary prevention.

Limitations

Use of pharmacy claims may result in misclassification of statin use patterns because some beneficiaries may not take the medication they filled while others may receive free samples
Other factors not considered in this analysis, including characteristics of the hospital where the patient was treated for their MI, may be associated with patterns of statin use
Reasons for statin down-titration or discontinuation were not analyzed because these data are not available in Medicare claims

Discussion

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Implication

Suboptimal long-term high-intensity statin adherence after MI in older Medicare patients warrants caution in assuming guideline-directed secondary prevention; leaves open whether targeted interventions improve outcomes.

Cite This Study

Colantonio et al. (2017) studied this question.

synapsesocial.com/papers/6a2a524090ba1aceec019c75 https://doi.org/10.1001/jamacardio.2017.0911

Topics

Statin therapy PCSK9 inhibitors Heart failure hospitalization

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Adherence to High-Intensity Statins Following a Myocardial Infarction Hospitalization Among Medicare Beneficiaries

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Topics

Adherence to High-Intensity Statins Following a Myocardial Infarction Hospitalization Among Medicare Beneficiaries

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

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