Healthcare Utilization and Statin Re‐Initiation Among Medicare Beneficiaries With a History of Myocardial Infarction

Abstract

BackgroundContact with the healthcare system represents an opportunity for individuals who discontinue statins to re‐initiate treatment. To help identify opportunities for healthcare providers to emphasize the risk‐lowering benefits accrued through restarting statins, we determined the types of healthcare utilization associated with statin re‐initiation among patients with history of a myocardial infarction.Methods and ResultsMedicare beneficiaries with a statin pharmacy fill claim within 30 days of hospital discharge for a myocardial infarction in 2007 to 2012 (n=158 795) were followed for 182 days postdischarge to identify treatment discontinuation, defined as 60 continuous days without statins (n=24 461). Re‐initiation was defined as a statin fill within 365 days of the discontinuation date (n=13 136). Using a case‐crossover study design and each beneficiary as their own control, healthcare utilization during 0 to 14 days before statin re‐initiation (case period) was compared with healthcare utilization 30 to 44 days before statin re‐initiation (control period). The mean age of beneficiaries was 75.4 years; 52.8% were women and 81.9% were white. For routine healthcare utilization, the odds ratio (95% confidence interval) for statin re‐initiation associated with lipid panel testing was 2.65 (1.93–3.65), outpatient primary care was 1.31 (1.23–1.40), and outpatient cardiologist care was 1.38 (1.28–1.50). For acute healthcare utilization, the odds ratio (95% confidence interval) for statin re‐initiation associated with emergency department visits was 1.77 (1.31–2.40), coronary heart disease (CHD) hospitalizations was 3.16 (2.41–4.14) and non–coronary heart disease hospitalizations was 1.73 (1.49–2.01).ConclusionsThe weaker association of routine versus acute healthcare utilization with statin re‐initiation suggests missed opportunities to reinforce the importance of statin therapy for secondary prevention.

Generating Practice-Based Evidence in the Use of Guideline-Recommended Combination Therapy for Secondary Prevention of Acute Myocardial Infarction

“…There is, however, evidence that the use of secondary-prevention medications for AMI patients has increased only moderately over time, even in cardiology practices [ 111 ]. Recent studies of Medicare beneficiaries [ 112 , 113 , 114 ], the Medical Expenditure Panel Survey (MEPS) [ 115 ], a registry cohort linked with Medicare claims [ 116 , 117 , 118 ], commercial insurance [ 119 ], and clinical trial [ 120 ] data report utilization rates similar to those found in this study (60–65% for ST and 35–40% for BB+AA+ST within 30 days post-discharge) and/or fairly stable treatment rates over the last 15 years. The patient mix within each drug combination, however, may have changed since the study period.…”

Missed opportunities in coronary artery disease: reflection on practice to improve patient outcomes

“…Statins are lipid-lowering drugs with proven effectiveness in CAD so there has been particular interest use of these agents in the secondary prevention after AMI. One study evaluated statin discontinuation at 182 days postdischarge for Medicare beneficiaries with a statin pharmacy fill claim within 30 days of hospital discharge for myocardial infarction in 2007–2012 [19]. They found that re-initiation of statin was associated with lipid panel testing (OR, 2.65; 95% CI, 1.93–3.65), outpatient primary care (OR, 1.31; 95% CI, 1.23–1.40) and outpatient cardiologist care (OR, 1.38; 95% CI, 1.28–1.50) for routing healthcare utilization and for acute healthcare utilization statin re-initiation was associated with emergency department visit (OR, 1.77; 95% CI, 1.31–2.40), coronary heart disease hospitalizations (OR, 3.16; 95% CI, 2.14–4.14) and noncoronary heart disease hospitalization (OR, 1.73; 95% CI, 1.49–2.01).…”