Utilization of and Adherence to Guideline-Recommended Lipid-Lowering Therapy After Acute Coronary Syndrome

Hirsh, Benjamin; Smilowitz, Nathaniel R.; Rosenson, Robert S.; Fuster, Valentín; Sperling, Laurence

doi:10.1016/j.jacc.2015.05.030

Cited by 102 publications

(68 citation statements)

References 61 publications

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“…Good adherence to guideline-recommended statin use has been proven to be associated with an improved outcome. (11)(12)(13) In a systematic review of statin discontinuation in high risk patients, Sandoval et al reported that poor adherence and withdrawal of statin therapy led to increased cardiovascular events, cerebrovascular events and mortality both in primary and secondary prevention, as well as in the pre-operative setting. Specifically, statin discontinuation was associated with a 67% increased risk of an acute myocardial infarction, suggesting a potential rebound effect after statin withdrawal.…”

Section: Where Do We Stand: Poor Adherence To Statin Usementioning

confidence: 99%

Comprehensive efforts to increase adherence to statin therapy

et al. 2017

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Section: Where Do We Stand: Poor Adherence To Statin Usementioning

confidence: 99%

Comprehensive efforts to increase adherence to statin therapy

et al. 2017

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“…(11) Poor adherence to statins has been associated with increased risk for recurrent cardiovascular events and mortality, increased healthcare costs, and preventable readmissions. (12–15) Previous studies have documented substantial nonadherence to statins after hospitalization for AMI,(16–18) but few data have been published on changes in adherence to statins from before to after an AMI hospitalization. (19) Determining the impact of an AMI hospitalization on adherence to statins after discharge can guide clinical expectations of statin adherence and can inform the design of interventions to improve adherence.…”

Section: Introductionmentioning

confidence: 99%

Impact of Hospitalization for Acute Myocardial Infarction on Adherence to Statins Among Older Adults

Kronish

Ross

Hong

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Background Little is known about the impact of hospitalization for an acute myocardial infarction (AMI) on subsequent adherence to statins. Methods and Results Using administrative claims from a 5% random sample of Medicare beneficiaries, we identified a cohort of Medicare patients ≥65 years, hospitalized from 2007–2011, taking statins in the year before AMI hospitalization (n=6,618). We then determined the proportion of patients nonadherent to statins (proportion of days covered [PDC] <80%) in the year before AMI hospitalization who became statin adherent (PDC ≥80%) in the year after AMI hospitalization. The proportion of statin adherent patients who became nonadherent was also studied. These proportions were compared with patients hospitalized for pneumonia (n=11,471) and patients not hospitalized (n=158,099) in 2010 and 2011. Among patients nonadherent to statins before AMI hospitalization, 37.7% became adherent after discharge. Patients hospitalized for AMI were more likely to become adherent than patients hospitalized for pneumonia (aRR 1.70, 95%CI 1.57–1.84) or patients not hospitalized (aRR 1.79, 95%CI 1.68–1.90). Among patients adherent to statins before AMI hospitalization, 32.6% became nonadherent after discharge. Those hospitalized for AMI were less likely to become nonadherent than those hospitalized for pneumonia (aRR 0.93, 95%CI 0.88–0.98) but more likely to become nonadherent than patients without hospitalizations (aRR 1.41, 95%CI 1.35–1.48). Conclusions Among nonadherent patients, hospitalization for AMI was associated with increased likelihood of becoming adherent to statins compared to hospitalization for pneumonia or no hospitalizations. Among adherent patients, hospitalization for AMI was associated with increased likelihood of becoming nonadherent to statins compared to no hospitalizations.

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“…In reality, many patients are either not at maximally tolerated doses or are non-adherent with their current therapies. (57) Optimizing therapies may reduce the size of the population who could potentially benefit from PCSK9 inhibitors, and our estimates may be an upper bound of the value of PCSK9 inhibitors in these populations. Also, other interventions besides PCSK9 inhibitors could be considered as comparators for cholesterol management, such as more aggressive lifestyle changes relevant to risk factors.…”

Section: Discussionmentioning

confidence: 95%

PCSK9 Inhibitors Show Value for Patients and the US Health Care System

2017

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OBJECTIVES Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors were approved by the U.S. Food and Drug Administration (FDA) as cholesterol-lowering therapies for patients with familial hypercholesterolemia or atherosclerotic cardiovascular disease. This study estimates the long-term health and economic value of PCSK9 inhibitors for older Americans (aged 51 and older). METHODS We conducted simulations using the Future Elderly Model (FEM), an established dynamic microsimulation model, to project the lifetime outcomes for the U.S. population aged 51 or older. Health effects estimates and confidence intervals from published meta-analysis studies were used to project changes in life expectancy, quality-adjusted life-years, and lifetime medical spending resulting from use of PCSK9 inhibitors. We considered two treatment scenarios: 1) current FDA eligibility; and 2) an extended eligibility scenario which includes patients with no pre-existing cardiovascular disease (CVD) but at high-risk. We assumed the price of PCSK9 inhibitors was discounted by 35% in the first 12 years and by 57% thereafter, with gradual uptake of the drug in eligible populations. RESULTS Utilization of PCSK9 inhibitors by individuals covered by current FDA approval would extend life-expectancy at age 51 by an estimated 1.1 years and would yield a lifetime net value of $5,800 per person. If utilization were extended to those at high-risk for CVD, PCSK9 inhibitors would generate a lifetime net benefit of $14,100 per person. CONCLUSION Expanded access to PCSK9 inhibitors would offer positive long-term net value for patients and the U.S. healthcare system at the current discounted prices.

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Utilization of and Adherence to Guideline-Recommended Lipid-Lowering Therapy After Acute Coronary Syndrome

Cited by 102 publications

References 61 publications

Comprehensive efforts to increase adherence to statin therapy

Comprehensive efforts to increase adherence to statin therapy

Impact of Hospitalization for Acute Myocardial Infarction on Adherence to Statins Among Older Adults

PCSK9 Inhibitors Show Value for Patients and the US Health Care System

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