Abstract 18092: Statin Use After an Acute In-Hospital Myocardial Infarction Among Medicare Beneficiaries
Background: American Heart Association (AHA) guidelines recommend all patients are discharged on a statin following a coronary heart disease (CHD) event. Many patients have an acute myocardial infarction (AMI) while hospitalized for another reason but the use of statins upon discharge in this population has not been well studied.
Methods: Using the Medicare 5% national random sample, we identified beneficiaries who had a hospital discharge diagnosis for AMI or who underwent coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) in 2007-2009. Medicare requires the primary diagnosis code to represent the initial reason for hospitalization; secondary discharge diagnosis codes capture complications including in-hospital AMI. Beneficiaries taking and not taking statins prior to their hospitalization were analyzed separately. Filling a statin prescription within 90 days after hospital discharge was identified using Medicare Part D claims.
Results: Of 5,810 and 8,517 Medicare beneficiaries taking and not taking statins prior to their CHD-related hospitalization, 84% and 55% filled a statin within 90 days of discharge, respectively. The proportion of beneficiaries filling a statin following discharge was substantially lower among those with a secondary versus primary discharge diagnosis of AMI, or PCI or CABG (Table). After multivariable adjustment, beneficiaries with a secondary discharge diagnosis of AMI were 41% (risk ratio = 0.59, 95% CI: 0.54 - 0.65) and 11% (risk ratio = 0.89; 95% CI: 0.82 - 0.97) less likely to fill a statin compared to those with a primary discharge diagnosis of AMI.
Conclusion: A high percentage of Medicare beneficiaries with in-hospital AMIs do not fill statins following hospital discharge. Reasons why patients with in-hospital AMIs do fill statins following discharge need to be identified.
- © 2013 by American Heart Association, Inc.