Use of Statins by Medicare Beneficiaries Post Myocardial Infarction

Schroeder, Mary C.; Robinson, Jennifer G.; Chapman, Cole G.; Brooks, John M.

doi:10.1177/0046958015571131

Cited by 6 publications

(6 citation statements)

References 14 publications

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“…Prescribing among patients cared for by specialist providers (eg, cardiologists) may have seen changes in prescribing patterns. Patients do not always fill their prescriptions for statin therapy 19 or other classes of medications, such as antihypertensives. 20 Assessment of statin therapy was made according to prescribing pattern not prescriptions fills, as this was beyond the scope of the analysis.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Statin Prescribing for Secondary Prevention in Primary Care Following New Guideline Recommendations

2015

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Section: Discussionmentioning

confidence: 99%

Evaluation of Statin Prescribing for Secondary Prevention in Primary Care Following New Guideline Recommendations

2015

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“…First, the observed treatment rates in each hospital referral region were calculated as the proportion of patients in the hospital referral region categorized as receiving surgery, physical therapy, and watchful waiting. Risk-adjusted treatment rates for each hospital referral region were then calculated as the average predicted probability of treatment, estimated with regression models as previously described, across patients in the hospital referral region 40 , 53 - 55 . The area treatment rate differential for each hospital referral region was finally calculated by subtracting the observed rate from the expected rate for each treatment.…”

Section: Methodsmentioning

confidence: 99%

Treatment for Rotator Cuff Tear Is Influenced by Demographics and Characteristics of the Area Where Patients Live

Chapman

Floyd

Thigpen

et al. 2018

JBJS OA

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Background:Atraumatic rotator cuff tear is a common orthopaedic complaint for people >60 years of age. Lack of evidence or consensus on appropriate treatment for this type of injury creates the potential for substantial discretion in treatment decisions. To our knowledge, no study has assessed the implications of this discretion on treatment patterns across the United States.Methods:All Medicare beneficiaries in the United States with a new magnetic resonance imaging (MRI)-confirmed atraumatic rotator cuff tear were identified with use of 2010 to 2012 Medicare administrative data and were categorized according to initial treatment (surgery, physical therapy, or watchful waiting). Treatment was modeled as a function of the clinical and demographic characteristics of each patient. Variation in treatment rates across hospital referral regions and the presence of area treatment signatures, representing the extent that treatment rates varied across hospital referral regions after controlling for patient characteristics, were assessed. Correlations between measures of area treatment signatures and measures of physician access in hospital referral regions were examined.Results:Among patients who were identified as having a new, symptomatic, MRI-confirmed atraumatic rotator cuff tear (n = 32,203), 19.8% were managed with initial surgery; 41.3%, with initial physical therapy; and 38.8%, with watchful waiting. Patients who were older, had more comorbidity, or were female, of non-white race, or dual-eligible for Medicaid were less likely to receive surgery (p < 0.0001). Black, dual-eligible females had 0.42-times (95% confidence interval [CI], 0.34 to 0.50) lower odds of surgery and 2.36-times (95% CI, 2.02 to 2.70) greater odds of watchful waiting. Covariate-adjusted odds of surgery varied dramatically across hospital referral regions; unadjusted surgery and physical therapy rates varied from 0% to 73% and from 6% to 74%, respectively. On average, patients in high-surgery areas were 62% more likely to receive surgery than the average patient with identical measured characteristics, and patients in low-surgery areas were half as likely to receive surgery than the average comparable patient. The supply of orthopaedic surgeons and the supply of physical therapists were associated with greater use of initial surgery and physical therapy, respectively.Conclusions:Patient characteristics had a significant influence on treatment for atraumatic rotator cuff tear but did not explain the wide-ranging variation in treatment rates across areas. Local-area physician supply and specialty mix were correlated with treatment, independent of the patient’s measured characteristics.

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“…The results from other work also suggest patient-centered treatment decisions and the use of practice-based evidence. In two previous papers, 62% of patients surviving an AMI had a statin available within 30 days of discharge, far below what was recommended by clinical guidelines [ 91 , 106 ]. In these studies, lower statin-use rates were observed for patients with complex comorbidities and a history of adverse events known to be correlated with statin use in population-based studies [ 107 , 108 ].…”

Section: Discussionmentioning

confidence: 99%

Generating Practice-Based Evidence in the Use of Guideline-Recommended Combination Therapy for Secondary Prevention of Acute Myocardial Infarction

et al. 2022

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Background: Clinical guidelines recommend beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers, and statins for the secondary prevention of acute myocardial infarction (AMI). It is not clear whether variation in real-world practice reflects poor quality-of-care or a balance of outcome tradeoffs across patients. Methods: The study cohort included Medicare fee-for-service beneficiaries hospitalized 2007–2008 for AMI. Treatment within 30-days post-discharge was grouped into one of eight possible combinations for the three drug classes. Outcomes included one-year overall survival, one-year cardiovascular-event-free survival, and 90-day adverse events. Treatment effects were estimated using an Instrumental Variables (IV) approach with instruments based on measures of local-area practice style. Pre-specified data elements were abstracted from hospital medical records for a stratified, random sample to create “unmeasured confounders” (per claims data) and assess model assumptions. Results: Each drug combination was observed in the final sample (N = 124,695), with 35.7% having all three, and 13.5% having none. Higher rates of guideline-recommended treatment were associated with both better survival and more adverse events. Unmeasured confounders were not associated with instrumental variable values. Conclusions: The results from this study suggest that providers consider both treatment benefits and harms in patients with AMIs. The investigation of estimator assumptions support the validity of the estimates.

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Use of Statins by Medicare Beneficiaries Post Myocardial Infarction

Cited by 6 publications

References 14 publications

Evaluation of Statin Prescribing for Secondary Prevention in Primary Care Following New Guideline Recommendations

Evaluation of Statin Prescribing for Secondary Prevention in Primary Care Following New Guideline Recommendations

Treatment for Rotator Cuff Tear Is Influenced by Demographics and Characteristics of the Area Where Patients Live

Generating Practice-Based Evidence in the Use of Guideline-Recommended Combination Therapy for Secondary Prevention of Acute Myocardial Infarction

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