Suboptimal statin adherence and discontinuation in primary and secondary prevention populations

Ellis, Jeffrey J.; Erickson, Steven R.; Stevenson, James G.; Bernstein, Steven J.; Stiles, Renée A.; Fendrick, A. Mark

doi:10.1111/j.1525-1497.2004.30516.x

Cited by 284 publications

(222 citation statements)

References 31 publications

(37 reference statements)

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“…Several studies have characterized the problem of statin discontinuation by identifying subgroups of patients who are at high risk for discontinuing treatment 14, 19, 20, 21, 22. Few studies have described opportunities to re‐initiate statins.…”

Section: Discussionmentioning

confidence: 99%

“…Determining whether statins are re‐initiated following specific types of healthcare encounters may identify opportunities to reinforce the importance of statin therapy for secondary prevention. In the current study, we identified healthcare utilization associated with statin re‐initiation among Medicare beneficiaries who were hospitalized for a myocardial infarction (MI) and had discontinued treatment 13, 14…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

Booth

Colantonio

Rosenson

et al. 2018

JAHA

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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.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Booth

Colantonio

Rosenson

et al. 2018

JAHA

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“…Women have less compliance to statin medication than men [6]. Poor adherence to statins may be related to medication costs and side effects.…”

Section: Introductionmentioning

confidence: 99%

Alternate Day Statin Dosing for Women with Previous Statin Intolerance

Minissian¹,

Waldman²,

Shufelt³

et al. 2016

Int J Nurs Clin Pract

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Background: HMG-CoA reductase inhibitors (statins) are efficacious for treatment and prevention of cardiovascular disease (CVD). Adherence is problematic due to side effects which prevent high risk patients from receiving benefit from statins. Aim: The aim of this study was to evaluate the effectiveness of a nurse practitioner (NP) alternate statin dosing protocol for the reduction of total cholesterol (TC) and low-density lipoprotein (LDL-C). Methods: 15 women who had the inability to tolerate daily dosing were analyzed using a novel NP protocol for initiation and maintenance of alternate dosing utilizing atorvastatin, pravastatin, or rosuvastatin. Patients were started on twice weekly statin dosing for 4 weeks then titrated up one dose per week as tolerated. While on alternate statin dosing, fasting lipid levels were ordered and obtained by chart review. We compared baseline and alternate day dosing by Wilcoxon signed rank test. Results: We evaluated 15 female patients with a mean age of 62 ± 14 years and BMI 26 ± 5 kg/m 2 . Overall, 60% had CVD, 60% had hypertension, 7% had diabetes, and 47% had a history of smoking but currently non-smokers. Prior to the study, all women were intolerant to 2 or more statins. Utilizing the alternate dosing NP protocol, we observed a 32% reduction in LDL-C, to a mean of 84 ± 39 mg/dl compared to the baseline mean of 134 ± 49 mg/dl (p<0.001)and a 20% reduction of TC (p<0.0001). Conclusions: Among women with statin intolerance, an NP statin alternate dosing protocol is effective in reducing TC and LDL-C levels. Further studies using this protocol are warranted in larger statin intolerant populations.

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“…In particular, it is not clear whether these symptoms are reproducible when rechallenged with a different or even the same statin. Consequently it is possible that statins may be discontinued inappropriately or unnecessarily, representing a major barrier to this potentially lifesaving therapy (13).…”

mentioning

confidence: 99%

“…Despite their well documented benefits, statins are commonly discontinued (12)(13)(14)(15). Statin discontinuation has been linked to increased risk of cardiovascular events and death in patients with coronary artery disease (16)(17)(18)(19).…”

mentioning

confidence: 99%