Factors associated with discharge lipid-lowering drug prescription in patients hospitalized for coronary artery disease (from the Get With the Guidelines database)

Abstract

Lipid-lowering therapy prevents morbidity and mortality in patients with coronary artery disease (CAD), but little is known regarding ordering practices in patients hospitalized with CAD events. Patients at participating hospitals of Get with The Guidelines-CAD, a hospital performance improvement program, were entered into a registry. Factors associated with discharge lipid-lowering therapy prescription were identified and the effect of in-hospital low-density lipoprotein cholesterol measurement on therapy prescription was evaluated. A total of 98,880 patients were enrolled at 405 hospitals. At discharge, lipid-lowering therapy was prescribed in 84.7% of patients and was associated with percutaneous coronary intervention and angiotensin-converting enzyme inhibitor, aspirin, and beta-blocker therapies at discharge, but not cardiac rehabilitation referral or coronary artery bypass grafting (all p<0.0001). After adjustment for patient characteristics, men were more likely (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.18 to 1.29; p<0.0001) and patients with heart failure were less likely to be prescribed lipid-lowering therapy (OR 0.64, 95% CI 0.59 to 0.69, p<0.0001). Patients who had low-density lipoprotein cholesterol measured during hospitalization were more likely to be prescribed lipid-lowering therapy (OR 1.56, 95% CI 1.48 to 1.65, p<0.0001). Lipid-lowering therapy prescription was associated positively with higher body mass index, history of dyslipidemia, and previous myocardial infarction and negatively with history of renal insufficiency, stroke, and hypertension. In conclusion, despite consistent benefits of lipid-lowering therapy in patients hospitalized for CAD events, discharge prescription varied by patient characteristics, in-hospital assessment, and treatment decisions. Additional efforts are needed to improve evidence-based lipid-lowering therapy prescription for eligible patients.