Statin Use Following Hospitalization Among Medicare Beneficiaries With a Secondary Discharge Diagnosis of Acute Myocardial Infarction

Abstract

BackgroundPatients with coronary heart disease are recommended to use statins following hospital discharge. Acute myocardial infarction (AMI) is a common complication of hospitalization, but the use of statins following discharge among patients who were not initially hospitalized for AMI has not been assessed adequately.Methods and ResultsUsing the Medicare 5% national random sample, we determined statin use among beneficiaries who were hospitalized and who had a secondary discharge diagnosis of AMI and among beneficiaries who had a primary discharge diagnosis of AMI, coronary artery bypass grafting, or percutaneous coronary intervention in 2007–2009. Statin use was defined by a pharmacy (Medicare Part D) claim within 90 days following discharge. Of 8175 Medicare beneficiaries who did not take statins prior to hospitalization, 31.2% with AMI as a secondary discharge diagnosis, 60.5% with AMI as the primary discharge diagnosis, 67.6% with coronary artery bypass grafting, and 63.9% with a percutaneous coronary intervention initiated statins. After multivariable adjustment, the risk ratio for statin initiation comparing beneficiaries with a secondary versus primary discharge diagnosis of AMI was 0.59 (95% CI 0.54 to 0.65). Among 5468 Medicare beneficiaries taking statins prior to hospitalization, statin use following discharge was lower for those with AMI as a secondary discharge diagnosis (71.8%) compared with their counterparts with AMI, coronary artery bypass grafting, and percutaneous coronary intervention (84.1%, 83.8%, and 87.3%, respectively) as the primary discharge diagnosis.ConclusionMedicare beneficiaries with a secondary hospital discharge diagnosis of AMI were less likely to fill statins compared with those with other coronary heart disease events.

Characteristics and Cardiovascular Disease Event Rates among African Americans and Whites Who Meet the Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk (FOURIER) Trial Inclusion Criteria

“…In the current study, a large proportion of African Americans and whites with clinically evident CVD were not taking statins and therefore did not meet the FOURIER inclusion criteria. This finding is consistent with prior studies showing suboptimal use of statin therapy and high rates of statin discontinuation following a CVD event, especially among African Americans [17][18][19][20].…”

Value of the Clinical Pharmacist Interventions in the Application of the American College of Cardiology (ACC/AHA) 2018 Guideline for Cholesterol Management

“…Accordingly, the initiation of statins, particularly high-intensity statins, is prescribed to far fewer patients than recommended. Consequently, the use of nonstatin therapies such as ezetimibe and PCSK9 inhibitors was nearly diminished, taking into consideration that several studies highlighted the importance of pharmacist intervention on cholesterol risk management and revealed the treatment gap between research evidence and clinical practice (9)(10)(11)(12).…”

Statin Discontinuation and Life‐Limiting Illness in Non–Skilled Stay Nursing Homes at Admission

“…D espite questionable benefits in some older adults, [1][2][3] statins are commonly used by Medicare beneficiaries. [4][5][6] In the United States, nearly half of adults older than 65 years were on a statin in 2012 to 2013. 7 Among patients with a life-limiting condition, statin use is prevalent, with half receiving statins in their last six months of life.…”

“…Association of Life-Limiting Illness Classification and Statin Discontinuation Within 30 Days of Nursing Home Admission (Resident n = 73,247; Facility n = 13,092) Sociodemographic variables include sex, age, race, activity of daily living status, cognitive impairment, and urban location status. Facility variables include ownership type, chain status, greater than 50% skilled nursing care, presence of full-time medical director, presence of physician extenders, registered nurse less than 30 minutes per resident/day, direct care less than 3 hours per resident/day, average of six or more medications per resident, and overall nursing home star quality rating(1)(2)(3)(4)(5).…”