title: Geographic variation in statin use for complex acute myocardial infarction patients: evidence of effective care?
abstract: BACKGROUND
  Despite strong evidence to designate statin use for secondary prevention of cardiovascular disease (CVD) as "effective care," observational studies show that many patients with CVD do not receive statins. This suggests that statin prescribing decisions for complex CVD patients are preference sensitive.
  
  
  OBJECTIVE
  The aim of this study was to evaluate local area variation in statin prescribing for subsets of complex patients after acute myocardial infarction (AMI) to assess whether current statin prescribing patterns fit profiles of either "effective care" or "preference-sensitive care."
  
  
  METHODS
  This was a retrospective cohort study of 124,618 Medicare patients with fee-for-service parts A, B, and D benefits who were hospitalized with AMI in 2008 or 2009 with no evidence of AMI in the past 12 months.
  
  
  METHODS
  Patient complexity was defined by the presence of diabetes, heart failure, and chronic kidney disease in the year before AMI admission. Local area practice styles for "no statin," "lower-intensity statins," and "high-intensity statins" were measured using the driving area for clinical care method. Statin prescribing rates for complex patient subsets were contrasted across patients grouped by local areas practice styles.
  
  
  RESULTS
  Lower statin treatment rates were observed for patients with complex conditions, especially among those with heart failure. However, substantial local area variation in statin prescribing is observed across all complex patient groups.
  
  
  CONCLUSIONS
  Despite guidelines promoting the use of statins for secondary prevention for CVD patients, substantial local area variation suggests that patient and provider beliefs and preferences weigh heavily in statin prescribing decisions.
authors.affiliation: *College of Pharmacy †College of Public Health, University of Iowa, Iowa City, IA.
authors.forename: John M
authors.initials: JM
authors.lastname: Brooks
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Cook
authors.forename: Cole G
authors.initials: CG
authors.lastname: Chapman
authors.forename: Puttarin
authors.initials: P
authors.lastname: Kulchaitanaroaj
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chrischilles
authors.forename: Stephen
authors.initials: S
authors.lastname: Welch
authors.forename: Jennifer
authors.initials: J
authors.lastname: Robinson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000517:prevention & control; D007674:Kidney Diseases / Q000517:prevention & control; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011322:Primary Prevention / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D012111:Residence Characteristics; D014481:United States / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors