title: Underutilization of high-intensity statin therapy after hospitalization for coronary heart disease.
abstract: BACKGROUND
  National guidelines recommend use of high-intensity statins after hospitalization for coronary heart disease (CHD) events.
  
  
  OBJECTIVE
  This study sought to estimate the proportion of Medicare beneficiaries filling prescriptions for high-intensity statins after hospital discharge for a CHD event and to analyze whether statin intensity before hospitalization is associated with statin intensity after discharge.
  
  
  METHODS
  We conducted a retrospective cohort study using a 5% random sample of Medicare beneficiaries between 65 and 74 years old. Beneficiaries were included in the analysis if they filled a statin prescription after a CHD event (myocardial infarction or coronary revascularization) in 2007, 2008, or 2009. High-intensity statins included atorvastatin 40 to 80 mg, rosuvastatin 20 to 40 mg, and simvastatin 80 mg.
  
  
  RESULTS
  Among 8,762 Medicare beneficiaries filling a statin prescription after a CHD event, 27% of first post-discharge fills were for a high-intensity statin. The percent filling a high-intensity statin post-discharge was 23.1%, 9.4%, and 80.7%, for beneficiaries not taking statins pre-hospitalization, taking low/moderate-intensity statins, and taking high-intensity statins before their CHD event, respectively. Compared with beneficiaries not on statin therapy pre-hospitalization, multivariable adjusted risk ratios for filling a high-intensity statin were 4.01 (3.58-4.49) and 0.45 (0.40-0.52) for participants taking high-intensity and low/moderate-intensity statins before their CHD event, respectively. Only 11.5% of beneficiaries whose first post-discharge statin fill was for a low/moderate-intensity statin filled a high-intensity statin within 365 days of discharge.
  
  
  CONCLUSIONS
  The majority of Medicare beneficiaries do not fill high-intensity statins after hospitalization for CHD.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: robert.rosenson@mssm.edu.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Rosenson
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Shia T
authors.initials: ST
authors.lastname: Kent
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Brown
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York; Division of Cardiology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farkouh
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Emily B
authors.initials: EB
authors.lastname: Levitan
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Huifeng
authors.initials: H
authors.lastname: Yun
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.affiliation: Department of Healthcare Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Meredith
authors.initials: M
authors.lastname: Kilgore
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
mesh_terms: D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000188:drug therapy* / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D010351:Patient Discharge; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D055502:Secondary Prevention; D014481:United States / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: coronary artery disease; drug use; hydroxymethylglutaryl-CoA reductase inhibitors; secondary prevention