Statin Utilization Patterns and Outcomes for Patients with Acute Coronary Syndrome During and Following Inpatient Admissions

Abstract

PurposeHigh-intensity statins (HIS) are recommended by current treatment guidelines for patients with clinical atherosclerotic cardiovascular disease and should be administered soon after an acute coronary syndrome (ACS) event and maintained thereafter. However, adherence to guidelines remains adequate. Statin utilization patterns during index hospitalization and the first year after ACS event, and the association between statin utilization and post-discharge clinical and economic outcomes, are described.MethodsRetrospective, observational study of US adults from the MarketScan Research Databases (2002–2014) with ≥ 1 inpatient admission for ACS and no evidence of previous ACS event < 12 months prior to index.ResultsIn total, 7802 patients met inclusion criteria. The most common index hospitalization primary diagnosis was myocardial infarction (94.6%). In the 3-month period before ACS admission, 3.4 and 14.9% of patients received HIS or low-to-moderate intensity statin, versus 13.2 and 30.7% during index hospitalization, and 16.4 and 45.1% in the year of follow-up. Of 1336 patients with a statin prescription filled on/after discharge, 53.2% filled prescriptions within 15 days of discharge and 14.9% delayed for > 91 days. The most common post-index hospital admissions for cardiovascular events were due to recurrent ACS (incidence rate = 115.2), heart failure (110.0), and revascularization (76.4). During follow-up, 2355 patients (30.2%) had all-cause inpatient admissions and 1136 (14.6%) had cardiovascular-specific admissions; mean all-cause medical and healthcare costs were $2456 and $2870, respectively, per patient per month.ConclusionsStatin dosing and utilization of HIS remains lower than recommended in current treatment guidelines, leaving patients at considerable risk of subsequent cardiovascular events.Electronic supplementary materialThe online version of this article (10.1007/s10557-018-6800-3) contains supplementary material, which is available to authorized users.

Diagnosis and Management of Statin Intolerance

“…This percentage increased to 13.2% during hospitalization and to 16.4% in the follow-up year. Most patients received low to moderate intensity statin doses (up to 45% in a year) 12) . Colantonio et al , retrospectively analyzed approximately 58,000 Medicare patients six months and two years after their hospitalization for MI, and found that the percentage of patients using HIS with high adherence dropped from 59% to 41.6%.…”

Statin therapy and low-density lipoprotein cholesterol reduction after acute coronary syndrome: Insights from the United Arab Emirates

“…Compared with other studies, we observed a low percentage of Emirati patients who received LLT (58.1%) while being at high risk of CV events. [ 22 23 24 ] Thus, it confirms that the use of statins in the UAE remains comparatively low despite the guideline recommendation worldwide. Further analysis showed that suboptimal dosing of statin prescription in secondary prevention and poor intensification of statin therapy were only moderate after ACS.…”

Clinical consequences of poor adherence to lipid-lowering therapy in patients with cardiovascular disease: can we do better?

“…Yet, in some regions there is suboptimal use of lipid-lowering therapy at time of discharge from ACS. For example, national registry data from the USA found 39.3% of patients were not prescribed any lipid-lowering therapy during a hospital admission for ACS, although this reduced to 22.3% by 1-year follow-up 4. This is different to registry data in New Zealand and Australia where 95%8 and 92.7%7 of patients, respectively, post-ACS were prescribed statins on discharge.…”

“…Among those with established atherosclerotic cardiovascular disease (ASCVD), poor statin adherence has been reported to be 47.2% in real-world registry data 2. Discontinuation rates have been reported ranging from 14%3 to 26.5%4 at 12 months in both large multicentre randomised clinical trial (RCT) data and national registries, with long-term discontinuation being 51% after 7 years in a large-scale RCT involving 39 countries 3. In a systematic review including 28 studies (5 nested case–control and 22 cohort studies), adherence to statin use in patients at high risk of ASCVD and those with established ASCVD was associated with a reduction in subsequent cardiovascular events (OR 1.22–5.26) and improved survival (OR 1.79–5.00) 5.…”