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Brief Report
April 19, 2017

Adherence to High-Intensity Statins Following a Myocardial Infarction Hospitalization Among Medicare Beneficiaries

Author Affiliations
  • 1Department of Epidemiology, University of Alabama at Birmingham
  • 2Center for Observational Research, Amgen Inc, Thousand Oaks, California
  • 3Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham
  • 4Department of Functional Sciences, University of Medicine and Pharmacy Victor Babes, Timisoara, Romania
  • 5Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham
  • 6Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York
JAMA Cardiol. Published online April 19, 2017. doi:10.1001/jamacardio.2017.0911
Key Points

Question  Do patients take high-intensity statins with high adherence after a myocardial infarction?

Findings  In this cohort study, 41.6% and 39.1% of patients aged 66 to 75 years and older than 75 years, respectively, who filled a high-intensity statin prescription within 30 days after a myocardial infarction hospitalization continued taking this medication with high adherence at 2 years postdischarge.

Meaning  A substantial proportion of patients filling high-intensity statin prescriptions following a myocardial infarction do not continue taking this medication with high adherence and may benefit from interventions aimed to improve high-intensity statin use.

Abstract

Importance  High-intensity statins are recommended following myocardial infarction. However, patients may not continue taking this medication with high adherence.

Objective  To estimate the proportion of patients filling high-intensity statin prescriptions following myocardial infarction who continue taking this medication with high adherence and to analyze factors associated with continuing a high-intensity statin with high adherence after myocardial infarction.

Design, Setting, and Participants  Retrospective cohort study of Medicare patients following hospitalization for myocardial infarction. Medicare beneficiaries aged 66 to 75 years (n = 29 932) and older than 75 years (n = 27 956) hospitalized for myocardial infarction between 2007 and 2012 who filled a high-intensity statin prescription (atorvastatin, 40-80 mg, and rosuvastatin, 20-40 mg) within 30 days of discharge. Beneficiaries had Medicare fee-for-service coverage including pharmacy benefits.

Exposures  Sociodemographic, dual Medicare/Medicaid coverage, comorbidities, not filling high-intensity statin prescriptions before their myocardial infarction (ie, new users), and cardiac rehabilitation and outpatient cardiologist visits after discharge.

Main Outcomes and Measures  High adherence to high-intensity statins at 6 months and 2 years after discharge was defined by a proportion of days covered of at least 80%, down-titration was defined by switching to a low/moderate-intensity statin with a proportion of days covered of at least 80%, and low adherence was defined by a proportion of days covered less than 80% for any statin intensity without discontinuation. Discontinuation was defined by not having a statin available to take in the last 60 days of each follow-up period.

Results  Approximately half of the beneficiaries were women and fourth-fifths were white. At 6 months and 2 years after discharge among beneficiaries 66 to 75 years of age, 17 633 (58.9%) and 10 308 (41.6%) were taking high-intensity statins with high adherence, 2605 (8.7%) and 3315 (13.4%) down-titrated, 5182 (17.3%) and 4727 (19.1%) had low adherence, and 3705 (12.4%) and 4648 (18.8%) discontinued their statin, respectively. The proportion taking high-intensity statins with high adherence increased between 2007 and 2012. African American patients, Hispanic patients, and new high-intensity statin users were less likely to take high-intensity statins with high adherence, and those with dual Medicare/Medicaid coverage and more cardiologist visits after discharge and who participated in cardiac rehabilitation were more likely to take high-intensity statins with high adherence. Results were similar among beneficiaries older than 75 years of age.

Conclusions and Relevance  Many patients filling high-intensity statins following a myocardial infarction do not continue taking this medication with high adherence for 2 years postdischarge. Interventions are needed to increase high-intensity statin use and adherence after myocardial infarction.

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