Abstract 13180: Clopidogrel Use Among Older Medicare Part D Enrollees after Receipt of a Drug Eluting Coronary Artery Stent
Background: Use of clopidogrel following percutaneous coronary intervention (PCI) with drug eluting coronary artery stent (DES) lowers the risk of stent thrombosis and death. We hypothesized that some older Americans are failing to fill a prescription for guideline-recommended clopidogrel after hospital discharge and that characteristics known at time of hospital discharge would predict this failure.
Methods: A retrospective analysis was performed using a 20% sample of individuals enrolled in fee-for-service Medicare Parts A, B and D in 2006–2007. The sample was limited to those 65 and older who received a DES during an acute-care hospitalization and survived at least 90 days without admission to a nursing facility. Using logistic regression, we estimated the adjusted probability of filling a clopidogrel prescription by age, sex, race, income, warfarin use, and comorbidities.
Results: We identified 23,636 individuals who received PCI with DES. Mean age was 75; 53.0% were female; 7.0% were black, 21.4% had an acute myocardial infarction (AMI) (7.9% ST elevation). In the 7 days following discharge, 61.3% of individuals filled a prescription for clopidogrel, rising to 82.1% by 90 days. The adjusted probability of filling a prescription for clopidogrel was significantly decreased with age >84, female sex, black race, longer hospital stay, depression, and dementia (Table). Potent predictors of not filling a prescription for clopidogrel within 7 days included age >84 (14% lower than 65–69) and dementia (21% lower than without the diagnosis). AMI and heart failure increased the probability of filling a prescription.
Conclusion: A significant proportion of patients fail to fill a prescription for clopidogrel in the 90 days following PCI with DES. Clinicians should review factors associated with lower probability of clopidogrel use at the time of hospital discharge and health systems should develop quality improvement initiatives that target this high-risk population.
- © 2010 by American Heart Association, Inc.