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Observational Study
. 2018 Jun;32(3):273-280.
doi: 10.1007/s10557-018-6800-3.

Statin Utilization Patterns and Outcomes for Patients with Acute Coronary Syndrome During and Following Inpatient Admissions

Susan H Boklage  1 , Elisabetta Malangone-Monaco  2 , Lorena Lopez-Gonzalez  2 , Yao Ding  2 , Caroline Henriques  2 , Joseph Elassal  3
Affiliations
Observational Study

Statin Utilization Patterns and Outcomes for Patients with Acute Coronary Syndrome During and Following Inpatient Admissions

Susan H Boklage et al. Cardiovasc Drugs Ther. 2018 Jun.

Abstract

Purpose: High-intensity statins (HIS) are recommended by current treatment guidelines for patients with clinical atherosclerotic cardiovascular disease and should be administered soon after an acute coronary syndrome (ACS) event and maintained thereafter. However, adherence to guidelines remains adequate. Statin utilization patterns during index hospitalization and the first year after ACS event, and the association between statin utilization and post-discharge clinical and economic outcomes, are described.

Methods: Retrospective, observational study of US adults from the MarketScan Research Databases (2002-2014) with ≥ 1 inpatient admission for ACS and no evidence of previous ACS event < 12 months prior to index.

Results: In total, 7802 patients met inclusion criteria. The most common index hospitalization primary diagnosis was myocardial infarction (94.6%). In the 3-month period before ACS admission, 3.4 and 14.9% of patients received HIS or low-to-moderate intensity statin, versus 13.2 and 30.7% during index hospitalization, and 16.4 and 45.1% in the year of follow-up. Of 1336 patients with a statin prescription filled on/after discharge, 53.2% filled prescriptions within 15 days of discharge and 14.9% delayed for > 91 days. The most common post-index hospital admissions for cardiovascular events were due to recurrent ACS (incidence rate = 115.2), heart failure (110.0), and revascularization (76.4). During follow-up, 2355 patients (30.2%) had all-cause inpatient admissions and 1136 (14.6%) had cardiovascular-specific admissions; mean all-cause medical and healthcare costs were $2456 and $2870, respectively, per patient per month.

Conclusions: Statin dosing and utilization of HIS remains lower than recommended in current treatment guidelines, leaving patients at considerable risk of subsequent cardiovascular events.

Keywords: Acute coronary syndrome; Cardiovascular events; Statin.

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Conflict of interest statement

Conflict of Interest

Ms. Boklage is an employee of and stockholder in Regeneron Pharmaceuticals, Inc. Dr. Elassal was an employee of and stockholder in Regeneron Pharmaceuticals, Inc. at the time the study was conducted. Dr. Ding, Ms. Malangone-Monaco, Ms. Lopez-Gonzalez, and Ms. Henriques are employees of Truven Health Analytics, an IBM company, which was provided funding to conduct this study on behalf of Regeneron Pharmaceuticals, Inc. and Sanofi.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Patient flow. ACS acute coronary syndrome. Superscript a indicates that the first observed inpatient admission for ACS occurring during this period (between January 1, 2002 and December 31, 2014) was recorded as the index date, provided that there was no evidence of a previous ACS event in the 12 months prior to this time. Superscript b indicates a hospital transfer. Superscript c indicates that patients were excluded if statin doses administered during the inpatient stay were below the lowest available or above the highest available doses
Fig. 2
Fig. 2
Statin treatment patterns in all patients by PDC ≥ 50% (N = 7802). ACS acute coronary syndrome, HIS high-intensity statin, LLT lipid-lowering therapy, LMIS low-to-moderate-intensity statin, PDC proportion of days covered. Superscript a identifies therapies assigned according to PDC in the 3-month pre-index hospitalization. Superscript b indicates that statins were prescribed in the outpatient setting for 64% of all patients
Fig. 3
Fig. 3
Proportion of patients filling statin prescriptions by time after ACS discharge (N = 1336a). ACS acute coronary syndrome, SD standard deviation. Superscript a indicates the number of patients with any statin prescription filled on or after ACS discharge, excludes patients with pre-index carryover statin at the time of discharge. Mean (SD) time to first statin prescription fill was 42.1 (71.3) days
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