Dropping the Ball on Statin Use at Discharge: Gaps in Guidelines Implementation
JACC in a Flash | The majority of patients do not fill high-intensity statin prescriptions following a hospitalization for a coronary heart disease event, according to a study published Jan. 19 in JACC.
The study, led by Robert S. Rosenson, MD, of the Icahn School of Medicine at Mount Sinai, New York, NY, used data from the Centers for Medicare and Medicaid Services (CMS) between 2007-2009. The researchers analyzed whether Medicare beneficiaries ages 65-74 filled statin prescriptions within 90 days of a hospital discharge for a coronary heart disease event, including acute myocardial infarction or coronary revascularization. Eligibility was also restricted to those patients who were hospitalized for less than 30 days and who had at least 90 day survival after hospital discharge.
The results of the study showed that only 35% of the 8,762 beneficiaries filled a high-intensity statin prescription within a year after discharge. Of those who filled their prescription, simvastatin was the most common high-intensity statin (49%), followed by atorvastatin (30%). Further, the study revealed that 80.7% of patients taking a high-intensity statin prior to their coronary heart disease event also filled a prescription for a high-intensity statin following hospital discharge. Of the patients not on a statin prior to hospitalization, 23.1 percent filled a high-intensity statin prescription following hospital discharge.
Despite recommendations of high-intensity statin therapy in coronary heart disease patients in the ACC/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, the study reveals that there is an underutilization of statin therapy in coronary heart disease patients after hospital discharge. The authors note that further study is needed to "access the influence of suboptimal management of care transitions on the use of high-intensity statin after coronary heart disease-related hospitalization."
In an accompanying editorial comment, Prakash Deedwania, MD, states that "the continued lag in implementing [guideline-directed medical therapy] remains worrisome, especially in light of the plethora of recent data clearly showing [optimal medical therapy] benefit in coronary artery disease patients... [This lag] deprives patients of evidence-based therapy and exposes them to future risk of major acute cardiovascular events that could be significantly reduced with proper secondary prevention."
- Rosenson R, Kent S, Brown T, et al. J Am Coll Cardiol. 2015;63:270-77.
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