Healthcare Utilization and Statin Re‐Initiation Among Medicare Beneficiaries With a History of Myocardial Infarction
BackgroundContact with the healthcare system represents an opportunity for individuals who discontinue statins to re‐initiate treatment. To help identify opportunities for healthcare providers to emphasize the risk‐lowering benefits accrued through restarting statins, we determined the types of heal...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2018-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.008462 |
| _version_ | 1819178698635476992 |
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| author | John N. Booth Lisandro D. Colantonio Robert S. Rosenson Monika M. Safford Ligong Chen Meredith L. Kilgore Todd M. Brown Benjamin Taylor Ricardo Dent Keri L. Monda Paul Muntner Emily B. Levitan |
| author_facet | John N. Booth Lisandro D. Colantonio Robert S. Rosenson Monika M. Safford Ligong Chen Meredith L. Kilgore Todd M. Brown Benjamin Taylor Ricardo Dent Keri L. Monda Paul Muntner Emily B. Levitan |
| author_sort | John N. Booth |
| collection | DOAJ |
| description | BackgroundContact with the healthcare system represents an opportunity for individuals who discontinue statins to re‐initiate treatment. To help identify opportunities for healthcare providers to emphasize the risk‐lowering benefits accrued through restarting statins, we determined the types of healthcare utilization associated with statin re‐initiation among patients with history of a myocardial infarction. Methods and ResultsMedicare beneficiaries with a statin pharmacy fill claim within 30 days of hospital discharge for a myocardial infarction in 2007 to 2012 (n=158 795) were followed for 182 days postdischarge to identify treatment discontinuation, defined as 60 continuous days without statins (n=24 461). Re‐initiation was defined as a statin fill within 365 days of the discontinuation date (n=13 136). Using a case‐crossover study design and each beneficiary as their own control, healthcare utilization during 0 to 14 days before statin re‐initiation (case period) was compared with healthcare utilization 30 to 44 days before statin re‐initiation (control period). The mean age of beneficiaries was 75.4 years; 52.8% were women and 81.9% were white. For routine healthcare utilization, the odds ratio (95% confidence interval) for statin re‐initiation associated with lipid panel testing was 2.65 (1.93–3.65), outpatient primary care was 1.31 (1.23–1.40), and outpatient cardiologist care was 1.38 (1.28–1.50). For acute healthcare utilization, the odds ratio (95% confidence interval) for statin re‐initiation associated with emergency department visits was 1.77 (1.31–2.40), coronary heart disease (CHD) hospitalizations was 3.16 (2.41–4.14) and non–coronary heart disease hospitalizations was 1.73 (1.49–2.01). ConclusionsThe weaker association of routine versus acute healthcare utilization with statin re‐initiation suggests missed opportunities to reinforce the importance of statin therapy for secondary prevention. |
| first_indexed | 2024-12-22T21:46:41Z |
| format | Article |
| id | doaj.art-33bb62b12a4b4076aa463cd67b294eda |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T21:46:41Z |
| publishDate | 2018-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-33bb62b12a4b4076aa463cd67b294eda2022-12-21T18:11:28ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-05-0171010.1161/JAHA.117.008462Healthcare Utilization and Statin Re‐Initiation Among Medicare Beneficiaries With a History of Myocardial InfarctionJohn N. Booth0Lisandro D. Colantonio1Robert S. Rosenson2Monika M. Safford3Ligong Chen4Meredith L. Kilgore5Todd M. Brown6Benjamin Taylor7Ricardo Dent8Keri L. Monda9Paul Muntner10Emily B. Levitan11Department of Epidemiology, University of Alabama at Birmingham, Birmingham, ALDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, ALDepartment of Medicine, Icahn School of Medicine at Mount Sinai, New York, NYDepartment of Medicine, Weill Cornell Medicine, New York, NYDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, ALDepartment of Health Care Organization and Policy, University of Alabama at Birmingham, ALDepartment of Medicine, University of Alabama at Birmingham, ALCenter for Observational Research, Amgen Inc., Thousand Oaks, CACenter for Observational Research, Amgen Inc., Thousand Oaks, CACenter for Observational Research, Amgen Inc., Thousand Oaks, CADepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, ALDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, ALBackgroundContact with the healthcare system represents an opportunity for individuals who discontinue statins to re‐initiate treatment. To help identify opportunities for healthcare providers to emphasize the risk‐lowering benefits accrued through restarting statins, we determined the types of healthcare utilization associated with statin re‐initiation among patients with history of a myocardial infarction. Methods and ResultsMedicare beneficiaries with a statin pharmacy fill claim within 30 days of hospital discharge for a myocardial infarction in 2007 to 2012 (n=158 795) were followed for 182 days postdischarge to identify treatment discontinuation, defined as 60 continuous days without statins (n=24 461). Re‐initiation was defined as a statin fill within 365 days of the discontinuation date (n=13 136). Using a case‐crossover study design and each beneficiary as their own control, healthcare utilization during 0 to 14 days before statin re‐initiation (case period) was compared with healthcare utilization 30 to 44 days before statin re‐initiation (control period). The mean age of beneficiaries was 75.4 years; 52.8% were women and 81.9% were white. For routine healthcare utilization, the odds ratio (95% confidence interval) for statin re‐initiation associated with lipid panel testing was 2.65 (1.93–3.65), outpatient primary care was 1.31 (1.23–1.40), and outpatient cardiologist care was 1.38 (1.28–1.50). For acute healthcare utilization, the odds ratio (95% confidence interval) for statin re‐initiation associated with emergency department visits was 1.77 (1.31–2.40), coronary heart disease (CHD) hospitalizations was 3.16 (2.41–4.14) and non–coronary heart disease hospitalizations was 1.73 (1.49–2.01). ConclusionsThe weaker association of routine versus acute healthcare utilization with statin re‐initiation suggests missed opportunities to reinforce the importance of statin therapy for secondary prevention.https://www.ahajournals.org/doi/10.1161/JAHA.117.008462case‐crossoverdiscontinuationre‐initiationstatinstatin discontinuationstatin re‐initiation |
| spellingShingle | John N. Booth Lisandro D. Colantonio Robert S. Rosenson Monika M. Safford Ligong Chen Meredith L. Kilgore Todd M. Brown Benjamin Taylor Ricardo Dent Keri L. Monda Paul Muntner Emily B. Levitan Healthcare Utilization and Statin Re‐Initiation Among Medicare Beneficiaries With a History of Myocardial Infarction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease case‐crossover discontinuation re‐initiation statin statin discontinuation statin re‐initiation |
| title | Healthcare Utilization and Statin Re‐Initiation Among Medicare Beneficiaries With a History of Myocardial Infarction |
| title_full | Healthcare Utilization and Statin Re‐Initiation Among Medicare Beneficiaries With a History of Myocardial Infarction |
| title_fullStr | Healthcare Utilization and Statin Re‐Initiation Among Medicare Beneficiaries With a History of Myocardial Infarction |
| title_full_unstemmed | Healthcare Utilization and Statin Re‐Initiation Among Medicare Beneficiaries With a History of Myocardial Infarction |
| title_short | Healthcare Utilization and Statin Re‐Initiation Among Medicare Beneficiaries With a History of Myocardial Infarction |
| title_sort | healthcare utilization and statin re initiation among medicare beneficiaries with a history of myocardial infarction |
| topic | case‐crossover discontinuation re‐initiation statin statin discontinuation statin re‐initiation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.008462 |
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