Author + information
- Susan Boklagea,b,
- Elisabetta Malangone-Monacoa,b,
- Lorena Lopez-Gonzaleza,b,
- Yao Dinga,b,
- Caroline Henriquesa,b,
- Joseph Elassala,b and
- Rishi Wadheraa,b
Background: Patients (pts) that present with acute coronary syndrome (ACS) are at high risk for recurrent cardiovascular (CV) events. Statin therapy (tx) reduces the risk of CV events and should be started during and following an ACS. The patterns of guideline-directed statin use during index ACS hospitalization are not clear.
Methods: Pts aged ≥ 18 years with ≥ 1 ACS (myocardial infarction or unstable angina requiring hospitalization) admission (index) were selected from administrative claims linked to hospital drug data between 2002 and 2014. Continuous enrollment of ≥ 12 months pre-index (baseline) was required. Pts with evidence of a previous ACS admission at baseline were excluded. Clinical characteristics, demographics and statin tx patterns were measured. Statin tx was categorized as: high intensity (HIS), low and moderate intensity (MIS), and no statin tx with assignment to a group based on at least 50% of the proportion of days covered (PDC). Pts who did not meet these criteria were placed into mixed tx as they had evidence of multiple intensity statins.
Results: A total of 7,802 pts (mean age 66.7, 66% male) met inclusion criteria. Approximately 31% of pts received statin therapy prior to the ACS admission, of which 82% were on MIS. An additional 8% were only taking non-statin tx during this time. During the ACS admission, only 13% of patients received high-intensity statin tx. Furthermore, for the other tx categories, 31% had MIS, 2% received monotherapy non-statin lipid tx, and 15% mixed tx during the index ACS. 29% had no evidence of tx during the index ACS despite an average length of stay of 4.7 days. For the first year post-discharge, statins were continued in the outpatient setting for 66% of all pts. Of those, 16% had HIS and 45% were on MIS, but 34% were not taking any statin for the majority of the year. Also of note, within 30 days of discharge, only 57% of pts had any statin.
Conclusions: This real-world analysis found that pts are both undertreated with and underutilizing ACC/AHA guideline-directed statin tx during, and up to the first year after, an index hospitalization for ACS. Further investigation into potential effects on utilization of healthcare services and subsequent CV events is warranted.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Coronary Syndromes, Diagnosis, Management and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1253-329
- 2017 American College of Cardiology Foundation