Author + information
- Received May 17, 2014
- Revision received September 9, 2014
- Accepted September 26, 2014
- Published online January 27, 2015.
- Robert S. Rosenson, MD∗∗ (, )
- Shia T. Kent, PhD†,
- Todd M. Brown, MD‡,
- Michael E. Farkouh, MD∗,‖,
- Emily B. Levitan, PhD†,
- Huifeng Yun, MD, PhD†,
- Pradeep Sharma, MS†,
- Monika M. Safford, MD‡,
- Meredith Kilgore, PhD§,
- Paul Muntner, PhD† and
- Vera Bittner, MD‡
- ∗Icahn School of Medicine at Mount Sinai, New York, New York
- †Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
- ‡Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- §Department of Healthcare Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama
- ‖Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
- ↵∗Reprint requests and correspondence:
Dr. Robert S. Rosenson, Icahn School of Medicine at Mount Sinai, Cardiovascular Institute, One Gustave L. Levy Place, Box 1030, New York, New York 10029.
Background National guidelines recommend use of high-intensity statins after hospitalization for coronary heart disease (CHD) events.
Objectives This study sought to estimate the proportion of Medicare beneficiaries filling prescriptions for high-intensity statins after hospital discharge for a CHD event and to analyze whether statin intensity before hospitalization is associated with statin intensity after discharge.
Methods We conducted a retrospective cohort study using a 5% random sample of Medicare beneficiaries between 65 and 74 years old. Beneficiaries were included in the analysis if they filled a statin prescription after a CHD event (myocardial infarction or coronary revascularization) in 2007, 2008, or 2009. High-intensity statins included atorvastatin 40 to 80 mg, rosuvastatin 20 to 40 mg, and simvastatin 80 mg.
Results Among 8,762 Medicare beneficiaries filling a statin prescription after a CHD event, 27% of first post-discharge fills were for a high-intensity statin. The percent filling a high-intensity statin post-discharge was 23.1%, 9.4%, and 80.7%, for beneficiaries not taking statins pre-hospitalization, taking low/moderate-intensity statins, and taking high-intensity statins before their CHD event, respectively. Compared with beneficiaries not on statin therapy pre-hospitalization, multivariable adjusted risk ratios for filling a high-intensity statin were 4.01 (3.58–4.49) and 0.45 (0.40–0.52) for participants taking high-intensity and low/moderate-intensity statins before their CHD event, respectively. Only 11.5% of beneficiaries whose first post-discharge statin fill was for a low/moderate-intensity statin filled a high-intensity statin within 365 days of discharge.
Conclusions The majority of Medicare beneficiaries do not fill high-intensity statins after hospitalization for CHD.
The collaboration on this project was derived from a clinical outcomes research grant given to the University of Alabama Birmingham from Amgen, Inc. (Thousand Oaks, California). Amgen, Inc. was not involved in the collection of data, analysis of data, or writing of this manuscript. Dr. Rosenson has served as a consultant to Aegerion, Amgen, Inc., Eli Lilly & Company, GlaxoSmithKline, Novartis, Regeneron, and Sanofi; has received research grants from Amgen, Inc., AstraZeneca, F. Hoffman LaRoche, and Sanofi; and has stock holdings in LipoScience, The Medicines Company, and Teva. Dr. Kent has received research grant support from Amgen, Inc. Dr. Brown has received research grant support from Amgen, Inc. Dr. Levitan has received research support from Amgen, Inc. Dr. Yun has received research support from Amgen, Inc. for unrelated work. Dr. Stafford has been a research investigator with Amgen, Inc.; and is a consultant for diaDexus. Dr. Kilgore has received research support from Amgen, Inc. Dr. Bittner has been a member of the steering committee for the Odyssey trial (sponsored by Sanofi and Regeneron); a coordinator on the STRENGTH trial (sponsored by AstraZeneca); a member of the advisory board for Amarin; a principal investigator for the TNT database (sponsored by Pfizer); a principal investigator for the STABILITY trial (sponsored by GlaxoSmithKline); and a coinvestigator on the Amgen grant to the University of Alabama at Birmingham. Dr. Muntner has served as a consultant for and receives grant support from Amgen, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Prakash Deedwania, MD, served as Guest Editor of this paper.
- Received May 17, 2014.
- Revision received September 9, 2014.
- Accepted September 26, 2014.
- American College of Cardiology Foundation