Abstract 16514: Temporal Trends in Statin Prescribing and Predictors of Treatment with High-Intensity Statins Among Patients with Acute Myocardial Infarction

Abstract

Background: The ACC/AHA guidelines for STEMI and NSTEMI/UA recommend that all ACS patients receive statin therapy irrespective of their LDL cholesterol. Randomized clinical trials have demonstrated that high intensity statin therapy is more effective at reducing adverse CV events compared with low or moderate intensity regimens. Little is known about prescribing patterns of statins in contemporary clinical practice.

Methods: We evaluated trends (using 3-month intervals) in statin prescribing in a cohort of 24,218 AMI patients hospitalized July 2006 to December 2010 using claims data from a large, nationwide health insurer. Intensive statin therapy was defined as simvastatin 80 mg, atorvastatin ≥ 40mg, rosuvastatin ≥ 20mg, or any statin taken with ezetimibe. Multivariable logistic regression was used to identify independent predictors for the prescribing of high intensity statins in AMI patients.

Results: Over the course of the study period, the proportion of AMI patients prescribed statins at hospital discharge significantly increased from 61% to 74% (Figure, p<0.001). There was a significant decline in the utilization of brand-name statins (44% to 29%; p<0.001). The proportion of patients prescribed intensive therapy increased but remained modest (26% to 31%, p=0.01). Younger patients, men, patients with a history of hyperlipidemia and those presenting with STEMI were significantly more likely to be prescribed intensive lipid lowering therapy at hospital discharge while patients with renal dysfunction and a prior history of ischemic stroke were significantly less likely (p<0.001 for all).

Conclusions: While prescribing of statins for AMI patients has increased over time, there is significant underutilization, particularly of more intensive regimens. There are differences in prescribing of intensive therapy based on age, gender, and clinical presentation. The prescribing of statins remains an important target for quality improvement initiatives.