Adherence to High-Intensity Statins Following a Myocardial Infarction Hospitalization Among Medicare Beneficiaries
Adherence to High-Intensity Statins Following a Myocardial Infarction Hospitalization Among Medicare Beneficiaries
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DOI：
10.1001/jamacardio.2017.0911
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发表时间：
2017-08-01
期刊：
影响因子：
24
通讯作者：
Rosenson, Robert S.
中科院分区：
文献类型：
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作者：
Colantonio, Lisandro D.;Huang, Lei;Rosenson, Robert S.
重要性：心肌梗死后推荐使用高强度他汀类药物。然而，患者可能不会坚持服用这种药物。目的评估心肌梗死后服用高强度他汀类药物的患者继续高依从性服用该药物的比例，并分析心肌梗死后继续高依从性服用高强度他汀类药物的相关因素。设计、环境和参与者：心肌梗死住院后医保患者的回顾性队列研究。2007年至2012年间因心肌梗死住院的66岁至75岁（n = 29932）和75岁以上（n = 27956）的医疗保险受益人在出院后30天内服用了高强度他汀类药物（阿托伐他汀，40- 80mg，瑞舒伐他汀，20-40mg）。受益人享有医疗保险按服务收费，包括药房福利。社会人口统计学，双重医疗保险/医疗补助覆盖，合并症，心肌梗死前未服用高强度他汀类药物（即新使用者），出院后心脏康复和门诊心脏病专家就诊。在出院后6个月和2年，高强度他汀类药物的高依从性被定义为覆盖天数比例至少为80%，低滴度被定义为切换到低/中等强度他汀类药物，覆盖天数比例至少为80%，低依从性被定义为在没有停药的情况下，任何他汀强度的覆盖天数比例小于80%。停药的定义是在每个随访期的最后60天内没有他汀类药物可用。结果大约一半的受益者是妇女，五分之四是白人。在66 - 75岁的受益人中，出院后6个月和2年，17633人（58.9%）和10308人（41.6%）服用高强度他汀类药物，高依从性，2605人（8.7%）和3315人（13.4%）下降，5182人（17.3%）和4727人（19.1%）低依从，3705人（12.4%）和4648人（18.8%）停止服用他汀类药物。2007年至2012年间，服用高强度他汀类药物的比例有所增加。非裔美国患者、西班牙裔患者和新的高强度他汀类药物使用者不太可能服用高依从性的高强度他汀类药物，而那些有双重医疗保险/医疗补助覆盖、出院后心脏病专家就诊次数较多以及参加心脏康复的患者更有可能服用高依从性的高强度他汀类药物。在75岁以上的受益人中，结果也相似。结论和相关性许多心肌梗死后服用高强度他汀类药物的患者在出院后2年内没有继续服用这种药物。需要采取干预措施，以增加心肌梗死后高强度他汀类药物的使用和依从性。
IMPORTANCE High-intensity statins are recommended following myocardial infarction. However, patients may not continue taking this medication with high adherence.OBJECTIVE To estimate the proportion of patients filling high-intensity statin prescriptions following myocardial infarction who continue taking this medication with high adherence and to analyze factors associated with continuing a high-intensity statin with high adherence after myocardial infarction.DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of Medicare patients following hospitalization for myocardial infarction. Medicare beneficiaries aged 66 to 75 years (n = 29 932) and older than 75 years (n = 27 956) hospitalized for myocardial infarction between 2007 and 2012 who filled a high-intensity statin prescription (atorvastatin, 40-80 mg, and rosuvastatin, 20-40mg) within 30 days of discharge. Beneficiaries had Medicare fee-for-service coverage including pharmacy benefits.EXPOSURES Sociodemographic, dual Medicare/Medicaid coverage, comorbidities, not filling high-intensity statin prescriptions before their myocardial infarction (ie, new users), and cardiac rehabilitation and outpatient cardiologist visits after discharge.MAIN OUTCOMES AND MEASURES High adherence to high-intensity statins at 6 months and 2 years after discharge was defined by a proportion of days covered of at least 80%, down-titration was defined by switching to a low/moderate-intensity statin with a proportion of days covered of at least 80%, and low adherence was defined by a proportion of days covered less than 80% for any statin intensity without discontinuation. Discontinuation was defined by not having a statin available to take in the last 60 days of each follow-up period.RESULTS Approximately half of the beneficiaries were women and fourth-fifths were white. At 6 months and 2 years after discharge among beneficiaries 66 to 75 years of age, 17 633 (58.9%) and 10 308 (41.6%) were taking high-intensity statins with high adherence, 2605 (8.7%) and 3315 (13.4%) down-titrated, 5182 (17.3%) and 4727 (19.1%) had low adherence, and 3705 (12.4%) and 4648 (18.8%) discontinued their statin, respectively. The proportion taking high-intensity statins with high adherence increased between 2007 and 2012. African American patients, Hispanic patients, and new high-intensity statin users were less likely to take high-intensity statins with high adherence, and those with dual Medicare/Medicaid coverage and more cardiologist visits after discharge and who participated in cardiac rehabilitation were more likely to take high-intensity statins with high adherence. Results were similar among beneficiaries older than 75 years of age.CONCLUSIONS AND RELEVANCE Many patients filling high-intensity statins following a myocardial infarction do not continue taking this medication with high adherence for 2 years postdischarge. Interventions are needed to increase high-intensity statin use and adherence after myocardial infarction.