Adherence to High-Intensity Statins After MI

Study Questions:

What is the proportion of patients filling high-intensity statin prescriptions following myocardial infarction (MI) who continue taking this medication with high adherence?

Methods:

The investigators used a retrospective cohort study design of Medicare patients following hospitalization for MI. Medicare beneficiaries aged 66-75 years (n = 29,932) and >75 years (n = 27,956) hospitalized for MI 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 were studied. Beneficiaries had Medicare fee-for-service coverage including pharmacy benefits. Sociodemographic, dual Medicare/Medicaid coverage, comorbidities, not filling high-intensity statin prescriptions before their MI (i.e., new users), and cardiac rehabilitation and outpatient cardiologist visits after discharge were analyzed. The main outcome measure was high adherence to high-intensity statins at 6 months and 2 years after discharge, which was defined by a proportion of days covered of ≥80%. Down-titration was defined by switching to a low-/moderate-intensity statin with a proportion of days covered of ≥80%, and low adherence was defined by a proportion of days covered <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 one-half of the beneficiaries were women and fourth-fifths were white. At 6 months and 2 years after discharge among beneficiaries 66-75 years of age, 17,633 (58.9%) and 10,308 (41.6%) were taking high-intensity statins with high adherence, 2,605 (8.7%) and 3,315 (13.4%) down-titrated, 5,182 (17.3%) and 4,727 (19.1%) had low adherence, and 3,705 (12.4%) and 4,648 (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 >75 years of age.

Conclusions:

The authors concluded that many patients filling high-intensity statins following an MI do not continue taking this medication with high adherence for 2 years postdischarge.

Perspective:

This study reports that most Medicare beneficiaries who filled a high-intensity statin prescription following an MI hospitalization did not continue taking this medication with high adherence for 2 years after discharge. Dual Medicare/Medicaid coverage, postdischarge cardiologist visits, and cardiac rehabilitation were associated with continuing to take a high-intensity statin with high adherence, and these factors could help formulate targeted interventions to improve high-intensity statin adherence and thereby reduce residual cardiovascular risk after heart attack. Full coverage of medications, including statins, has been shown to reduce the risk for major vascular events or revascularization after an MI in prior studies, and may be a cost-effective way to improve adherence and outcomes.

Clinical Topics: Acute Coronary Syndromes, Diabetes and Cardiometabolic Disease, Dyslipidemia, Geriatric Cardiology, Prevention, Nonstatins, Novel Agents, Statins

Keywords: Acute Coronary Syndrome, Cardiac Rehabilitation, Comorbidity, Dyslipidemias, Geriatrics, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Medicare, Medication Adherence, Metabolic Syndrome X, Myocardial Infarction, Myocardial Ischemia, Outcome Assessment (Health Care), Primary Prevention, Risk Factors


< Back to Listings