Abstract 15677: Statin Prescription and Dose Intensity Among Elderly Medicare Beneficiaries, by CV Disease Diagnosis and Prescriber Specialty
Introduction: Statin use is known to benefit elderly patients with cardiovascular (CV) disease. However, little is known about the rate and dose of statin prescriptions or prescriber specialty among elderly Medicare beneficiaries with a history of various CV diseases.
Method: In this retrospective analysis of 2007-2010 Medicare claims data, we identified enrollees with history of prevalent CV disease or diabetes (DM) (N=613,674, 68% women, 7.5% black, mean [±SD] age 76.7 [±8] years). We used a disease hierarchy approach and included 9 subgroups: patients with a history of myocardial infarction (MI), unstable angina, ischemic stroke, stable angina, transient ischemic attack (TIA), carotid stenosis, coronary revascularization (PCI/CAB), peripheral arterial disease (PAD), or DM. We identified statin users at diagnosis or within 12 months post-diagnosis; categorized statin therapy as high-, moderate-, and low-intensity; and examined the clinical specialty of statin prescribers.
Results: Overall, 41% of patients had at least one cardiologist visit in 2010. Statin use was highest among PCI/CAB patients (81.5%) and lowest among PAD patients (45.5%) (Table 1). Similar proportions of patients with MI (72.8%) and unstable angina (71.4%) were prescribed statins. High-intensity and low-intensity statins were most commonly prescribed to MI patients (22%) and TIA patients (13.7%), respectively. Overall, family/internal medicine was the most common specialty of statin prescribers across all CV disease groups (Table 2). PCI/CAB patients were most likely to receive prescriptions from cardiologists (23.8%). Endocrinologists prescribed 2.3% of statins for DM patients. Most PAD patients (62.9%) were prescribed statins by family/internal medicine clinicians.
Conclusions: Statin use is lower among elderly PAD and TIA patients. More comprehensive assessment of statin use is needed, and of its determinants and associated outcomes in elderly CV patients.
Author Disclosures: A. Yusuf: None. C. Wiggenhorn: None. J. Hardin: Employment; Significant; Amgen, Inc. R.D. Kilpatrick: Employment; Significant; Amgen, Inc. C.A. Herzog: Other Research Support; Modest; Gilead, Zoll (pending). Honoraria; Modest; ClearView Healthcare Partners, Keryx, UpToDate. Ownership Interest; Modest; Boston Scientific, Cambridge Heart, GE, Johnson & Johnson, Merck. Consultant/Advisory Board; Modest; AbbVie, Amgen, Fibrogen, Fish & Richardson, PC, GSK, Keryx, ZS Pharma.
- © 2014 by American Heart Association, Inc.