title: Statin use following hospitalization among Medicare beneficiaries with a secondary discharge diagnosis of acute myocardial infarction.
abstract: BACKGROUND
  Patients with coronary heart disease are recommended to use statins following hospital discharge. Acute myocardial infarction (AMI) is a common complication of hospitalization, but the use of statins following discharge among patients who were not initially hospitalized for AMI has not been assessed adequately.
  
  
  RESULTS
  Using the Medicare 5% national random sample, we determined statin use among beneficiaries who were hospitalized and who had a secondary discharge diagnosis of AMI and among beneficiaries who had a primary discharge diagnosis of AMI, coronary artery bypass grafting, or percutaneous coronary intervention in 2007-2009. Statin use was defined by a pharmacy (Medicare Part D) claim within 90 days following discharge. Of 8175 Medicare beneficiaries who did not take statins prior to hospitalization, 31.2% with AMI as a secondary discharge diagnosis, 60.5% with AMI as the primary discharge diagnosis, 67.6% with coronary artery bypass grafting, and 63.9% with a percutaneous coronary intervention initiated statins. After multivariable adjustment, the risk ratio for statin initiation comparing beneficiaries with a secondary versus primary discharge diagnosis of AMI was 0.59 (95% CI 0.54 to 0.65). Among 5468 Medicare beneficiaries taking statins prior to hospitalization, statin use following discharge was lower for those with AMI as a secondary discharge diagnosis (71.8%) compared with their counterparts with AMI, coronary artery bypass grafting, and percutaneous coronary intervention (84.1%, 83.8%, and 87.3%, respectively) as the primary discharge diagnosis.
  
  
  CONCLUSIONS
  Medicare beneficiaries with a secondary hospital discharge diagnosis of AMI were less likely to fill statins compared with those with other coronary heart disease events.
authors: Department of Epidemiology, University of Alabama-Birmingham, Birmingham, AL (H.Y., S.K., P.S., E.D., P.M., E.B.L.).
authors: Huifeng
authors: H
authors: Yun
authors: School of Medicine, University of Alabama-Birmingham, Birmingham, AL (M.M.S., T.M.B., V.B.).
authors: Monika M
authors: MM
authors: Safford
authors: School of Medicine, University of Alabama-Birmingham, Birmingham, AL (M.M.S., T.M.B., V.B.).
authors: Todd M
authors: TM
authors: Brown
authors: Icahn School of Medicine at Mount Sinai, New York, NY (M.E.F., R.S.R.) Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada (M.E.F.).
authors: Michael E
authors: ME
authors: Farkouh
authors: Department of Epidemiology, University of Alabama-Birmingham, Birmingham, AL (H.Y., S.K., P.S., E.D., P.M., E.B.L.).
authors: Shia
authors: S
authors: Kent
authors: Department of Epidemiology, University of Alabama-Birmingham, Birmingham, AL (H.Y., S.K., P.S., E.D., P.M., E.B.L.).
authors: Pradeep
authors: P
authors: Sharma
authors: Department of Health Care Organization and Policy, University of Alabama-Birmingham, Birmingham, AL (M.K.).
authors: Meredith
authors: M
authors: Kilgore
authors: School of Medicine, University of Alabama-Birmingham, Birmingham, AL (M.M.S., T.M.B., V.B.).
authors: Vera
authors: V
authors: Bittner
authors: Icahn School of Medicine at Mount Sinai, New York, NY (M.E.F., R.S.R.).
authors: Robert S
authors: RS
authors: Rosenson
authors: Department of Epidemiology, University of Alabama-Birmingham, Birmingham, AL (H.Y., S.K., P.S., E.D., P.M., E.B.L.).
authors: Elizabeth
authors: E
authors: Delzell
authors: Department of Epidemiology, University of Alabama-Birmingham, Birmingham, AL (H.Y., S.K., P.S., E.D., P.M., E.B.L.).
authors: Paul
authors: P
authors: Muntner
authors: Department of Epidemiology, University of Alabama-Birmingham, Birmingham, AL (H.Y., S.K., P.S., E.D., P.M., E.B.L.).
authors: Emily B
authors: EB
authors: Levitan
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000534:rehabilitation; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D006278:Medicare; D054524:Medicare Part D / Q000706:statistics & numerical data*; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D010351:Patient Discharge / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000534:rehabilitation; D014481:United States
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Medicare; atherosclerosis; hospitalization; myocardial infarction; statins