High-intensity Statin Therapy After Hospitalization for CHD
High-intensity Statin Therapy After Hospitalization for CHD
There were 8,762 beneficiaries <75 years of age who met the inclusion criteria and filled a statin prescription within 90 days of discharge after their CHD event. Simvastatin was the most common statin filled (48.6%) followed by atorvastatin (29.6%) (Table 1). Of beneficiaries who filled a statin prescription within 90 days of their CHD event, 27% filled a high-intensity statin: 15.7% filled atorvastatin 40 or 80 mg, 7.8% simvastatin 80 mg, and 3.5% rosuvastatin 20 or 40 mg (Table 2). Among the 8,019 beneficiaries with 365 days of follow-up, 35% filled a high-intensity statin at any time within the post-discharge period.
Before their index event, 16.8% of beneficiaries had filled a high-intensity statin prescription, 53.1% had filled a low/moderate-intensity statin, and 30.1% had no statin fills (Table 3). Compared with beneficiaries not taking statins before their events, those taking low/moderate- or high-intensity statins were less likely to have had an acute MI as their index CHD event. Those not taking statins before their CHD event were less likely to have diabetes or a history of CHD, have seen a cardiologist before their index event, or be taking ≥10 medications.
With the exception of beneficiaries whose last fill before their CHD event was for a high-intensity statin, fewer than 30% of beneficiaries in every sub-group had a first fill for a high-intensity statin after their CHD event (Table 4, left panel). Among participants whose last statin fill before their CHD event was a high-intensity statin, 80.7% filled a high-intensity statin after their CHD event. In comparison, 23.1% of beneficiaries not taking statins and 9.4% of those whose last statin fill before their CHD event was a low/moderate-intensity statin filled a high-intensity statin after their CHD event. After multivariable adjustment, when compared with beneficiaries not taking a statin before their CHD event, beneficiaries taking a high-intensity statin were 4.01 times more likely to have their first statin fill be for a high-intensity statin (multivariable adjusted RR: 4.01; 95% CI: 3.58 to 4.49). Also, after multivariable adjustment, beneficiaries taking low/moderate-intensity statins versus not taking statins during the look-back period and those who experienced a CABG or PCI versus acute MI were less likely to have a first fill after a CHD event for a high-intensity statin.
Overall, 35% of Medicare beneficiaries filled a high-intensity statin prescription within a year after hospital discharge (Table 4, right panel). Among participants not on a statin before their CHD event, 29.6% filled a high-intensity statin during the post-discharge period compared with 18.8% and 87.3% of participants taking low/moderate- and high-intensity statins during the look-back period, respectively. With the exception of those taking high-intensity statins during the look-back period, fewer than 40% of participants in all subgroups filled a high-intensity statin within the 365 days after hospital discharge. Results were similar when the analysis sample was not restricted to those <75 years of age (Online Table 1 http://content.onlinejacc.org/data/Journals/JAC/931924/09088_mmc1.pdf?v=635579210585500000). Additionally, results were similar when Medicare beneficiaries with ESRD were excluded (data not shown).
Of beneficiaries whose first fill after discharge was a high-intensity statin, 18.8% switched to a low/moderate-intensity statin during the year after hospital discharge (Online Table 2 http://content.onlinejacc.org/data/Journals/JAC/931924/09088_mmc1.pdf?v=635579210585500000). Beneficiaries taking a high-intensity statin before hospitalization were less likely to switch to a low/moderate-intensity statin. Conversely, of beneficiaries who filled a low/moderate-intensity prescription as their first statin post-discharge, 11.5% filled a high-intensity statin during the 365 days after hospital discharge. A higher percentage (34.6%) of beneficiaries who were taking a high-intensity statin during the look-back period switched from a low/moderate- to a high-intensity statin during the year after hospital discharge compared with beneficiaries not taking statins (9.7%) or taking low/moderate-intensity statins (10.5%) during the look-back period.
Results
There were 8,762 beneficiaries <75 years of age who met the inclusion criteria and filled a statin prescription within 90 days of discharge after their CHD event. Simvastatin was the most common statin filled (48.6%) followed by atorvastatin (29.6%) (Table 1). Of beneficiaries who filled a statin prescription within 90 days of their CHD event, 27% filled a high-intensity statin: 15.7% filled atorvastatin 40 or 80 mg, 7.8% simvastatin 80 mg, and 3.5% rosuvastatin 20 or 40 mg (Table 2). Among the 8,019 beneficiaries with 365 days of follow-up, 35% filled a high-intensity statin at any time within the post-discharge period.
Before their index event, 16.8% of beneficiaries had filled a high-intensity statin prescription, 53.1% had filled a low/moderate-intensity statin, and 30.1% had no statin fills (Table 3). Compared with beneficiaries not taking statins before their events, those taking low/moderate- or high-intensity statins were less likely to have had an acute MI as their index CHD event. Those not taking statins before their CHD event were less likely to have diabetes or a history of CHD, have seen a cardiologist before their index event, or be taking ≥10 medications.
With the exception of beneficiaries whose last fill before their CHD event was for a high-intensity statin, fewer than 30% of beneficiaries in every sub-group had a first fill for a high-intensity statin after their CHD event (Table 4, left panel). Among participants whose last statin fill before their CHD event was a high-intensity statin, 80.7% filled a high-intensity statin after their CHD event. In comparison, 23.1% of beneficiaries not taking statins and 9.4% of those whose last statin fill before their CHD event was a low/moderate-intensity statin filled a high-intensity statin after their CHD event. After multivariable adjustment, when compared with beneficiaries not taking a statin before their CHD event, beneficiaries taking a high-intensity statin were 4.01 times more likely to have their first statin fill be for a high-intensity statin (multivariable adjusted RR: 4.01; 95% CI: 3.58 to 4.49). Also, after multivariable adjustment, beneficiaries taking low/moderate-intensity statins versus not taking statins during the look-back period and those who experienced a CABG or PCI versus acute MI were less likely to have a first fill after a CHD event for a high-intensity statin.
Overall, 35% of Medicare beneficiaries filled a high-intensity statin prescription within a year after hospital discharge (Table 4, right panel). Among participants not on a statin before their CHD event, 29.6% filled a high-intensity statin during the post-discharge period compared with 18.8% and 87.3% of participants taking low/moderate- and high-intensity statins during the look-back period, respectively. With the exception of those taking high-intensity statins during the look-back period, fewer than 40% of participants in all subgroups filled a high-intensity statin within the 365 days after hospital discharge. Results were similar when the analysis sample was not restricted to those <75 years of age (Online Table 1 http://content.onlinejacc.org/data/Journals/JAC/931924/09088_mmc1.pdf?v=635579210585500000). Additionally, results were similar when Medicare beneficiaries with ESRD were excluded (data not shown).
Of beneficiaries whose first fill after discharge was a high-intensity statin, 18.8% switched to a low/moderate-intensity statin during the year after hospital discharge (Online Table 2 http://content.onlinejacc.org/data/Journals/JAC/931924/09088_mmc1.pdf?v=635579210585500000). Beneficiaries taking a high-intensity statin before hospitalization were less likely to switch to a low/moderate-intensity statin. Conversely, of beneficiaries who filled a low/moderate-intensity prescription as their first statin post-discharge, 11.5% filled a high-intensity statin during the 365 days after hospital discharge. A higher percentage (34.6%) of beneficiaries who were taking a high-intensity statin during the look-back period switched from a low/moderate- to a high-intensity statin during the year after hospital discharge compared with beneficiaries not taking statins (9.7%) or taking low/moderate-intensity statins (10.5%) during the look-back period.