Patterns of statin initiation, intensification, and maximization among patients hospitalized with an acute myocardial infarction.
BACKGROUND
Intensive statins are superior to moderate statins in reducing morbidity and mortality after an acute myocardial infarction. Although studies have documented rates of statin prescription as a quality performance measure, variations in hospitals' rates of initiating, intensifying, and maximizing statin therapy after acute myocardial infarction are unknown.


RESULTS
We assessed statin use at admission and discharge among 4340 acute myocardial infarction patients from 24 US hospitals (2005-2008). Hierarchical models estimated site variation in statin initiation in naïve patients, intensification in those undergoing submaximal therapy, and discharge on maximal therapy (defined as a statin with expected low-density lipoprotein cholesterol lowering ≥ 50%) after adjustment for patient factors, including low-density lipoprotein cholesterol level. Site variation was explored with a median rate ratio, which estimates the relative difference in risk ratios of 2 hypothetically identical patients at 2 different hospitals. Among statin-naïve patients, 87% without a contraindication were prescribed a statin, with no variability across sites (median rate ratio, 1.02). Among patients who arrived on submaximal statins, 26% had their statin therapy intensified, with modest site variability (median rate ratio, 1.47). Among all patients without a contraindication, 23% were discharged on maximal statin therapy, with substantial hospital variability (median rate ratio, 2.79).


CONCLUSIONS
In a large, multicenter acute myocardial infarction cohort, statin therapy was begun in nearly 90% of patients during hospitalization, with no variability across sites; however, rates of statin intensification and maximization were low and varied substantially across hospitals. Given that more intense statin therapy is associated with better outcomes, changing the existing performance measures to include the intensity of statin therapy may improve care.
From Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., M.K., F.T., J.A.S.); Eli Lilly, Indianapolis, IN (Z.Z., P.L.M., J.B.); and Eastern Colorado Health Care System, Denver, CO (T.M.M.).
Suzanne V
SV
Arnold
Mikhail
M
Kosiborod
Fengming
F
Tang
Zhenxiang
Z
Zhao
Thomas M
TM
Maddox
Patrick L
PL
McCollam
Julie
J
Birt
John A
JA
Spertus
D000368:Aged; D003920:Diabetes Mellitus / Q000401:mortality; D004305:Dose-Response Relationship, Drug; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D006949:Hyperlipidemias / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D012044:Regression Analysis; D012307:Risk Factors
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
lipids; myocardial infarction; secondary prevention; statins, HMG-CoA