Association of Region and Hospital and Patient Characteristics With Use of High-Intensity Statins After Myocardial Infarction Among Medicare Beneficiaries

Bittner, Vera; Colantonio, Lisandro D.; Dai, Yuling; Woodward, Mark; Mefford, Matthew T.; Rosenson, Robert S.; Muntner, Paul; Monda, Keri L.; Kilgore, Meredith L.; Jaeger, Byron C.; Levitan, Emily B.

doi:10.1001/jamacardio.2019.2481

Cited by 22 publications

(21 citation statements)

References 31 publications

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“…However, these previous studies are largely limited to a specific population, eg, patient with CHD or within a specific region, health system, or insurance plan. 12 , 25 , 26 , 27 , 28 , 29 , 30 To our knowledge, this is the first study to assess the contemporary trends in a large national cohort of patients both less than or more than age 65 years with various ASCVD types receiving care in diverse routine practice settings. The findings highlight major treatment gaps that warrant future study.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Trends in Statin Therapy for Secondary Prevention of Atherosclerotic Cardiovascular Disease in US Adults From 2007 to 2016

et al. 2020

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IMPORTANCE Atherosclerotic cardiovascular disease (ASCVD) is highly prevalent in the US, with studies indicating substantial rates of nonadherence to and undertreatment with statin therapy. The 2013 American College of Cardiology/American Heart Association guideline recommended highintensity statins for all patients age 75 years and younger with documented ASCVD in whom such therapy is tolerated, but there is limited evidence documenting population trends of statin use, adherence, and outcomes in the periods before and after the update to the guideline. OBJECTIVE To assess trends in the use, adherence, cost, and outcomes of statin therapy for secondary prevention in patients with different types of ASCVD between 2007 and 2016. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the OptumLab Data Warehouse database containing privately insured and Medicare Advantage enrollees with demographic characteristics similar to the national US population. Participants were adult patients (age Ն21 years) who had their first ASCVD event between January 1, 2007, and December 31, 2016. Data were characterized as belonging to 3 groups: (1) cardiovascular heart disease (CHD); (2) ischemic stroke or transient ischemic attack (TIA); and (3) peripheral artery disease (PAD). Data were analyzed from July 1 to August 1, 2018. EXPOSURES Calendar year of the initial ASCVD event. MAIN OUTCOMES AND MEASURES Trends in the statin use (within 30 days of discharge from hospitalization), adherence (proportion of days covered Ն80% within the first year), cost, major adverse cardiac events (1-year cumulative risk), and statin intolerance (within the first year). RESULTS Of the 284 954 patients with a new ASCVD event, 128 422 (45.1%) were women; the median age was 63 years (interquartile range [IQR], 54-72 years); 207 781 (72.9%) were White. The use of statins increased from 50.3% in 2007 to 59.9% in 2016, the use of high-intensity statins increased from 25.0% to 49.2%, and the adherence increased from 58.7% to 70.5% (P < .001 for all trends). Patients with CHD were more likely to receive statins and high-intensity statins and adhere to medications than patients with ischemic stroke, TIA, or PAD despite similar observed treatment benefit. In 2016, 80.9% of patients with CHD used a statin vs 65.8% of patients with ischemic stroke or TIA and 37.5% of patients with PAD.

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Section: Discussionmentioning

confidence: 99%

Assessment of Trends in Statin Therapy for Secondary Prevention of Atherosclerotic Cardiovascular Disease in US Adults From 2007 to 2016

et al. 2020

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“…Prior studies have reported regional and state-level variation in both cardiovascular outcomes and practice [ 11 – 14 ]. Geographic variation in cardiovascular pharmacotherapy, specifically, has been described [ 15 – 17 ]. We sought to identify if prescribing is universally low or whether geographic variation exists in the prescribing of cardioprotective antihyperglycemic agents.…”

Section: Introductionmentioning

confidence: 99%

County-level variation in cardioprotective antihyperglycemic prescribing among medicare beneficiaries

Hanna

Nargesi

Essien

et al. 2022

American Journal of Preventive Cardiology

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“… 24 , 25 In the US, adherence to similar guidance on statins was strongly associated with geography, indicating that local policy or culture plays an important role. 26 …”

Section: Discussionmentioning

confidence: 99%

“…24,25 In the US, adherence to similar guidance on statins was strongly associated with geography, indicating that local policy or culture plays an important role. 26 Previous work has shown that doctors tend to respond rapidly to safety concerns around prescribing, whereas evidencebased guidelines have less impact. 27,28 The present findings support this, showing minimal response to the 2014 guidelines, but a rapid reduction in simvastatin 40 mg in 2012, coinciding with a Medicines and Healthcare products Regulatory Agency (MHRA) drug safety alert on simvastatin >20 mg, with corresponding increases in simvastatin 20 mg and atorvastatin.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Prescription of suboptimal statin treatment regimens: a retrospective cohort study of trends and variation in English primary care

et al. 2020

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BackgroundSince 2014 English national guidance recommends ‘high-intensity’ statins, reducing low-density lipoprotein (LDL) cholesterol by ≥40%.AimTo describe trends and variation in low-/medium-intensity statin prescribing and assess the feasibility of rapid prescribing behaviour change.Design and settingA retrospective cohort study using OpenPrescribing data from all 8142 standard NHS general practices in England from August 2010 to March 2019.MethodStatins were categorised as high- or low-/medium-intensity using two different thresholds, and the proportion prescribed below these thresholds was calculated. The authors plotted trends and geographical variation, carried out mixed-effects logistic regression to identify practice characteristics associated with breaching of guidance, and used indicator saturation to identify sudden prescribing changes.ResultsThe proportion of statins prescribed below the recommended 40% LDL-lowering threshold has decreased gradually from 80% in 2011/2012 to 45% in 2019; the proportion below a pragmatic 37% threshold decreased from 30% to 18% in 2019. Guidance from 2014 had minimal impact on trends. Wide variation was found between practices (interdecile ranges 20% to 85% and 10% to 30% respectively in 2018). Regression identified no strong associations with breaching of guidance. Indicator saturation identified several practices exhibiting sudden changes towards greater guideline compliance.ConclusionBreaches of guidance on choice of statin remain common, with substantial variation between practices. Some have implemented rapid change, indicating the feasibility of rapid prescribing behaviour change. This article discusses the potential for a national strategic approach, using data and evidence to optimise care, including targeted education alongside audit and feedback to outliers through services such as OpenPrescribing.

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Association of Region and Hospital and Patient Characteristics With Use of High-Intensity Statins After Myocardial Infarction Among Medicare Beneficiaries

Cited by 22 publications

References 31 publications

Assessment of Trends in Statin Therapy for Secondary Prevention of Atherosclerotic Cardiovascular Disease in US Adults From 2007 to 2016

Assessment of Trends in Statin Therapy for Secondary Prevention of Atherosclerotic Cardiovascular Disease in US Adults From 2007 to 2016

County-level variation in cardioprotective antihyperglycemic prescribing among medicare beneficiaries

Prescription of suboptimal statin treatment regimens: a retrospective cohort study of trends and variation in English primary care

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