title: In-hospital initiation of lipid-lowering therapy after coronary intervention as a predictor of long-term utilization: a propensity analysis.
abstract: BACKGROUND
  Despite multiple randomized trials demonstrating their efficacy for the secondary prevention of coronary disease, lipid-lowering agents remain underused. Few studies have examined the relationship between predischarge initiation of lipid-lowering therapy and long-term use.
  
  
  METHODS
  Using data from patients at 69 centers from the United States and Canada enrolled in the Evaluation in PTCA to Improve Long-term Outcome With Abciximab GP IIb/IIIa Blockade (EPILOG) trial, we performed a retrospective propensity-analyzed cohort study. Patients underwent percutaneous coronary intervention for stable or recently unstable coronary disease and were older than 21 years, were not taking lipid-lowering therapy at the time of admission, and survived to hospital discharge; 175 were discharged taking lipid-lowering therapy and 1951 were not.
  
  
  RESULTS
  After 6 months, 77% of patients who started taking lipid-lowering agents before hospital discharge continued taking therapy, compared with only 25% of those discharged without these agents (relative risk, 3.17; 95% confidence interval, 2.88-3.41; P<.001). After restricting the analysis to propensity-matched patients (n = 477) and adjusting for other potential confounders, initiation of a lipid-lowering agent during hospitalization was the strongest independent predictor of use at 6 months (relative risk, 2.50; 95% confidence interval, 2.29-2.65; P<.001).
  
  
  CONCLUSIONS
  Inpatient initiation of lipid-lowering therapy is a strong and independent positive predictor of subsequent use, with patients who start taking lipid-lowering therapy before hospital discharge nearly 3 times as likely to be taking these agents 6 months later. Inpatient initiation of lipid-lowering therapy appears to be an effective strategy for bridging the gap between current medical knowledge and practice.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Pennsylvania Medical Center and Philadelphia Veterans Administration Medical Center, Philadelphia, PA, USA.
authors.forename: Herbert D
authors.initials: HD
authors.lastname: Aronow
authors.forename: Gian M
authors.initials: GM
authors.lastname: Novaro
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lauer
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Brennan
authors.forename: A Michael
authors.initials: AM
authors.lastname: Lincoff
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Topol
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Kereiakes
authors.forename: Steven E
authors.initials: SE
authors.lastname: Nissen
mesh_terms: D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003327:Coronary Disease / Q000517:prevention & control*; D004363:Drug Utilization; D005260:Female; D006760:Hospitalization; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D000960:Hypolipidemic Agents; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab