Abstract
PurposeHigh-intensity statins (HIS) are recommended by current treatment guidelines for patients with clinical atherosclerotic cardiovascular disease and should be administered soon after an acute coronary syndrome (ACS) event and maintained thereafter. However, adherence to guidelines remains adequate. Statin utilization patterns during index hospitalization and the first year after ACS event, and the association between statin utilization and post-discharge clinical and economic outcomes, are described.MethodsRetrospective, observational study of US adults from the MarketScan Research Databases (2002–2014) with ≥ 1 inpatient admission for ACS and no evidence of previous ACS event < 12 months prior to index.ResultsIn total, 7802 patients met inclusion criteria. The most common index hospitalization primary diagnosis was myocardial infarction (94.6%). In the 3-month period before ACS admission, 3.4 and 14.9% of patients received HIS or low-to-moderate intensity statin, versus 13.2 and 30.7% during index hospitalization, and 16.4 and 45.1% in the year of follow-up. Of 1336 patients with a statin prescription filled on/after discharge, 53.2% filled prescriptions within 15 days of discharge and 14.9% delayed for > 91 days. The most common post-index hospital admissions for cardiovascular events were due to recurrent ACS (incidence rate = 115.2), heart failure (110.0), and revascularization (76.4). During follow-up, 2355 patients (30.2%) had all-cause inpatient admissions and 1136 (14.6%) had cardiovascular-specific admissions; mean all-cause medical and healthcare costs were $2456 and $2870, respectively, per patient per month.ConclusionsStatin dosing and utilization of HIS remains lower than recommended in current treatment guidelines, leaving patients at considerable risk of subsequent cardiovascular events.
Highlights
Acute coronary syndrome (ACS) refers to a spectrum of clinical symptoms compatible with acute myocardial ischemia and includes the diagnosis of unstable angina and myocardialElectronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.infarction (MI) with or without ST elevation [1, 2]
Based on fill patterns and corresponding proportion of days covered (PDC) categorization, in the 3 months prior to index, 267 (3.4%), 1162 (14.9%), and 6141 (78.7%) patients were assigned to High-intensity statins (HIS), low-to-moderate intensity statins (LMIS), and no statin treatment, respectively
Despite evidence that treatment with statins, especially HIS, reduces the risk of cardiovascular events in high-risk patients with atherosclerotic cardiovascular disease (ASCVD) [8], results from the present study showed that a considerable proportion of patients did not receive any statin during index hospitalization
Summary
In 2010, the estimated number of unique hospitalizations for ACS in the USA was 1,141,000 [3]. The estimated annual cost of ACS was $150 billion in the USA in 2008 [2]. Following an initial ACS event, patients are at high risk of recurrent cardiovascular events [4,5,6]. Reducing low-density lipoprotein cholesterol (LDL-C) with statin therapy reduces the risk of cardiovascular events in high-risk patients with atherosclerotic cardiovascular disease (ASCVD) [7,8,9,10]. In the PROVE-IT trial of patients with a recent ACS event, an intensive lipid-lowering statin regimen (high-intensity statins [HIS]) provided greater protection against death or major cardiovascular events than a standard LMIS regimen [7]
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