Patterns of Statin Initiation, Intensification, and Maximization Among Patients Hospitalized with an Acute Myocardial Infarction
Background—Intensive statins are superior to moderate statins in reducing morbidity and mortality after an acute myocardial infarction (AMI). While studies have documented rates of statin prescription as a quality performance measure, variations in hospitals' rates of initiating, intensifying and maximizing statin therapy after AMI are unknown.
Methods and Results—We assessed statins at admission and discharge among 4340 AMI patients from 24 US hospitals (2005-08). Hierarchical models estimated site variation in statin initiation in naïve patients, intensification in those on sub-maximal therapy, and discharge on maximal therapy (defined as a statin with expected LDL-C lowering ≥50%), after adjusting for patient factors including LDL-C. Site variation was explored with a median rate ratio (MRR), which estimates the relative difference in risk ratios of 2 hypothetically identical patients at 2 different hospitals. Among statin naïve patients, 87% without a contraindication were prescribed a statin, with no variability across sites (MRR 1.02). Among patients who arrived on sub-maximal statins, 26% had their statin therapy intensified with modest site variability (MRR 1.47). Among all patients without a contraindication, 23% were discharged on maximal statin therapy with substantial hospital variability (MRR 2.79).
Conclusions—In a large, multicenter AMI cohort, nearly 90% of patients were started on statins during hospitalization, with no variability across sites. However, rates of statin intensification and maximization were low and varied substantially across hospitals. Given that more intense statin therapy is associated with better outcomes, changing the existing performance measures to include the intensity of statin therapy may improve care.
- Received May 6, 2013.
- Revision received December 13, 2013.
- Accepted December 19, 2013.