Key result
Prior high-intensity statin use linked to ~4-fold higher post-CHD high-intensity fills in Medicare patients.
Why the study?
National guidelines recommend high-intensity statins after hospitalization for CHD events, prompting this study to estimate post-discharge high-intensity statin fill rates among Medicare beneficiaries and evaluate the association between pre-hospitalization and post-discharge statin intensity.
Does pre-hospitalization statin intensity influence the likelihood of filling a high-intensity statin prescription after hospital discharge for a coronary heart disease event in Medicare beneficiaries aged 65 to 74?
Cohort (n=8,762)
Yes
Does pre-hospitalization statin intensity influence the likelihood of filling a high-intensity statin prescription after hospital discharge for a coronary heart disease event in Medicare beneficiaries aged 65 to 74?
Despite national guideline recommendations, the majority of Medicare beneficiaries do not fill high-intensity statin prescriptions after hospitalization for a coronary heart disease event, and post-discharge statin intensity is strongly driven by pre-hospitalization statin regimen.
Underuse after CHD discharge warrants discharge-time vigilance in Medicare patients; leaves open optimal interventions to overcome pre-hospitalization inertia.
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.
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Rosenson et al. (2015) conducted a cohort in Coronary heart disease (myocardial infarction or coronary revascularization) (n=8,762). Pre-hospitalization statin therapy intensity (high-intensity vs. low/moderate-intensity) vs. No statin therapy pre-hospitalization was evaluated on Filling a high-intensity statin prescription after hospital discharge for a CHD event (RR 4.01, 95% CI 3.58-4.49). High-intensity statin therapy was filled by only 27% of Medicare patients post-CHD discharge, strongly driven by pre-admission statin intensity (adjusted RR 4.01 for prior high-intensity vs no statin).
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