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It’s not too late to improve statin adherence: Association between changes in Statin adherence from before to after acute myocardial infarction and all-cause mortality
Journal article   Open access

It’s not too late to improve statin adherence: Association between changes in Statin adherence from before to after acute myocardial infarction and all-cause mortality

Ryan P Hickson, Jennifer G Robinson, Izabela E Annis, Ley A Killeya-Jones and Gang Fang
Journal of the American Heart Association, Vol.8(7), pp.e011378-e011378
2019
DOI: 10.1161/JAHA.118.011378
PMCID: PMC6509715
PMID: 30929542
url
https://doi.org/10.1161/JAHA.118.011378View
Published (Version of record) Open Access

Abstract

Background Many older patients have a change in statin adherence-either an increase or a decrease-from before to after an acute myocardial infarction ( AMI ), but its association with mortality is unknown. Methods and Results Using Medicare administrative claims, a cohort of patients ≥66years old with an AMI hospitalization from 2008 to 2010 was assembled. Statin adherence was measured for 180days pre- AMI and 180days post- AMI and categorized as severely nonadherent, moderately nonadherent, or adherent. Categorical change in statin adherence from pre- to post- AMI was assessed. Patients were then followed for up to 18months for all-cause mortality. A Cox proportional hazards model was applied to estimate the effects of statin adherence change on all-cause mortality, adjusted for patient baseline characteristics. Of 101011 eligible patients, 20% had a categorical increase in adherence, 16% decreased, and 14% remained nonadherent both pre- and post- AMI . Compared with patients who were always severely nonadherent (both pre- and post- AMI ), patients whose adherence increased from severely nonadherent to adherent (hazard ratio=0.83; 95% CI : 0.75-0.92) and patients who were always adherent (hazard ratio=0.88; 95% CI : 0.82-0.94) were less likely to die; patients whose adherence decreased from moderately nonadherent to severely nonadherent were more likely to die (hazard ratio=1.11; 95% CI : 1.01-1.22). Conclusions After an AMI , patients with decreased statin adherence had the worst mortality outcomes. However, patients with increased statin adherence had a similar risk of mortality compared with continuously adherent patients, suggesting that, even after an AMI , it is not too late to improve statin adherence.

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