Statin use after acute myocardial infarction by patient complexity: are the rates right?

John M Brooks; Elizabeth Cook; Cole G Chapman; Mary C Schroeder; Elizabeth A Chrischilles; Kathleen M Schneider; Puttarin Kulchaitanaroaj; Jennifer Robinson

doi:10.1097/MLR.0000000000000322

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Statin use after acute myocardial infarction by patient complexity: are the rates right?

Journal article

Peer reviewed

Statin use after acute myocardial infarction by patient complexity: are the rates right?

John M Brooks, Elizabeth Cook, Cole G Chapman, Mary C Schroeder, Elizabeth A Chrischilles, Kathleen M Schneider, Puttarin Kulchaitanaroaj and Jennifer Robinson

Medical care, Vol.53(4), pp.324-331

04/2015

DOI: 10.1097/MLR.0000000000000322

PMCID: PMC6410704

PMID: 25719431

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https://www.ncbi.nlm.nih.gov/pmc/articles/6410704View

Open Access

Abstract

Guidelines suggest statin use after acute myocardial infarction (AMI) should be close to universal in patients without safety concerns yet rates are much lower than recommended, decline with patient complexity, and display substantial geographic variation. Trial exclusions have resulted in little evidence to guide statin prescribing for complex patients. To assess the benefits and risks associated with higher rates of statin use after AMI by baseline patient complexity. Sample includes Medicare fee-for-service patients with AMIs in 2008-2009. Instrumental variable estimators using variation in local area prescribing patterns by statin intensity as instruments were used to assess the association of higher statin prescribing rates by statin intensity on 1-year survival, adverse events, and cost by patient complexity. Providers seem to have individualized statin use across patients based on potential risks. Higher statin rates for noncomplex AMI patients were associated with increased survival rates with little added adverse event risk. Higher statin rates for complex AMI patients were associated with tradeoffs between higher survival rates and higher rates of adverse events. Higher rates of statin use for noncomplex AMI patients are associated with outcome rate changes similar to existing evidence. For the complex patients in our study, who were least represented in existing trials, higher statin-use rates were associated with survival gains and higher adverse event risks not previously documented. Policy interventions promoting higher statin-use rates for complex patients may need to be reevaluated taking careful consideration of these tradeoffs.

Comorbidity

United States

Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage

Acute Disease

Insurance Claim Review - statistics & numerical data

Risk Assessment

Humans

Medicare - statistics & numerical data

Male

Myocardial Infarction - drug therapy

Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use

Aged, 80 and over

Female

Aged

Drug Utilization - statistics & numerical data

Practice Guidelines as Topic

Details

Title: Subtitle: Statin use after acute myocardial infarction by patient complexity: are the rates right?
Creators: John M Brooks - University of South Carolina System
Elizabeth Cook
Cole G Chapman - University of South Carolina System
Mary C Schroeder
Elizabeth A Chrischilles - University of Iowa, Epidemiology
Kathleen M Schneider
Puttarin Kulchaitanaroaj
Jennifer Robinson
Resource Type: Journal article
Publication Details: Medical care, Vol.53(4), pp.324-331
DOI: 10.1097/MLR.0000000000000322
PMID: 25719431
PMCID: PMC6410704
NLM abbreviation: Med Care
ISSN: 1537-1948
eISSN: 1537-1948
Publisher: United States
Grant note: RC4 AG038635 / NIA NIH HHS 1R21HS019574-01 / AHRQ HHS R21 HS019574 / AHRQ HHS
Language: English
Date published: 04/2015
Academic Unit: Pharmacy; Epidemiology; Pharmacy Practice and Science; Internal Medicine
Record Identifier: 9983995107402771

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11 Times Cited - Web of Science

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