It's Not Too Late to Improve Statin Adherence: Association Between Changes in Statin Adherence from Before to After Acute Myocardial Infarction and All‐Cause Mortality
Background Many older patients have a change in statin adherence—either an increase or a decrease—from before to after an acute myocardial infarction (AMI), but its association with mortality is unknown. Methods and Results Using Medicare administrative claims, a cohort of patients ≥66 years old wit...
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| Format: | Article |
| Language: | English |
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Wiley
2019-04-01
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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.118.011378 |
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| author | Ryan P. Hickson Jennifer G. Robinson Izabela E. Annis Ley A. Killeya‐Jones Gang Fang |
| author_facet | Ryan P. Hickson Jennifer G. Robinson Izabela E. Annis Ley A. Killeya‐Jones Gang Fang |
| author_sort | Ryan P. Hickson |
| collection | DOAJ |
| description | Background Many older patients have a change in statin adherence—either an increase or a decrease—from before to after an acute myocardial infarction (AMI), but its association with mortality is unknown. Methods and Results Using Medicare administrative claims, a cohort of patients ≥66 years old with an AMI hospitalization from 2008 to 2010 was assembled. Statin adherence was measured for 180 days pre‐AMI and 180 days post‐AMI and categorized as severely nonadherent, moderately nonadherent, or adherent. Categorical change in statin adherence from pre‐ to post‐AMI was assessed. Patients were then followed for up to 18 months for all‐cause mortality. A Cox proportional hazards model was applied to estimate the effects of statin adherence change on all‐cause mortality, adjusted for patient baseline characteristics. Of 101 011 eligible patients, 20% had a categorical increase in adherence, 16% decreased, and 14% remained nonadherent both pre‐ and post‐AMI. Compared with patients who were always severely nonadherent (both pre‐ and post‐AMI), patients whose adherence increased from severely nonadherent to adherent (hazard ratio=0.83; 95% CI: 0.75–0.92) and patients who were always adherent (hazard ratio=0.88; 95% CI: 0.82–0.94) were less likely to die; patients whose adherence decreased from moderately nonadherent to severely nonadherent were more likely to die (hazard ratio=1.11; 95% CI: 1.01–1.22). Conclusions After an AMI, patients with decreased statin adherence had the worst mortality outcomes. However, patients with increased statin adherence had a similar risk of mortality compared with continuously adherent patients, suggesting that, even after an AMI, it is not too late to improve statin adherence. |
| first_indexed | 2024-04-13T16:31:25Z |
| format | Article |
| id | doaj.art-73a6c61865264bca993bde9fdbd907ca |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:31:25Z |
| publishDate | 2019-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-73a6c61865264bca993bde9fdbd907ca2022-12-22T02:39:34ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-04-018710.1161/JAHA.118.011378It's Not Too Late to Improve Statin Adherence: Association Between Changes in Statin Adherence from Before to After Acute Myocardial Infarction and All‐Cause MortalityRyan P. Hickson0Jennifer G. Robinson1Izabela E. Annis2Ley A. Killeya‐Jones3Gang Fang4Division of Pharmaceutical Outcomes and Policy UNC Eshelman School of Pharmacy University of North Carolina at Chapel Hill Chapel Hill NCDepartment of Epidemiology College of Public Health University of Iowa Iowa City IADivision of Pharmaceutical Outcomes and Policy UNC Eshelman School of Pharmacy University of North Carolina at Chapel Hill Chapel Hill NCDivision of Pharmaceutical Outcomes and Policy UNC Eshelman School of Pharmacy University of North Carolina at Chapel Hill Chapel Hill NCDivision of Pharmaceutical Outcomes and Policy UNC Eshelman School of Pharmacy University of North Carolina at Chapel Hill Chapel Hill NCBackground Many older patients have a change in statin adherence—either an increase or a decrease—from before to after an acute myocardial infarction (AMI), but its association with mortality is unknown. Methods and Results Using Medicare administrative claims, a cohort of patients ≥66 years old with an AMI hospitalization from 2008 to 2010 was assembled. Statin adherence was measured for 180 days pre‐AMI and 180 days post‐AMI and categorized as severely nonadherent, moderately nonadherent, or adherent. Categorical change in statin adherence from pre‐ to post‐AMI was assessed. Patients were then followed for up to 18 months for all‐cause mortality. A Cox proportional hazards model was applied to estimate the effects of statin adherence change on all‐cause mortality, adjusted for patient baseline characteristics. Of 101 011 eligible patients, 20% had a categorical increase in adherence, 16% decreased, and 14% remained nonadherent both pre‐ and post‐AMI. Compared with patients who were always severely nonadherent (both pre‐ and post‐AMI), patients whose adherence increased from severely nonadherent to adherent (hazard ratio=0.83; 95% CI: 0.75–0.92) and patients who were always adherent (hazard ratio=0.88; 95% CI: 0.82–0.94) were less likely to die; patients whose adherence decreased from moderately nonadherent to severely nonadherent were more likely to die (hazard ratio=1.11; 95% CI: 1.01–1.22). Conclusions After an AMI, patients with decreased statin adherence had the worst mortality outcomes. However, patients with increased statin adherence had a similar risk of mortality compared with continuously adherent patients, suggesting that, even after an AMI, it is not too late to improve statin adherence.https://www.ahajournals.org/doi/10.1161/JAHA.118.011378behavior changemedication adherencemyocardial infarctionolder adultssecondary prevention |
| spellingShingle | Ryan P. Hickson Jennifer G. Robinson Izabela E. Annis Ley A. Killeya‐Jones Gang Fang It's Not Too Late to Improve Statin Adherence: Association Between Changes in Statin Adherence from Before to After Acute Myocardial Infarction and All‐Cause Mortality Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease behavior change medication adherence myocardial infarction older adults secondary prevention |
| title | It's Not Too Late to Improve Statin Adherence: Association Between Changes in Statin Adherence from Before to After Acute Myocardial Infarction and All‐Cause Mortality |
| title_full | It's Not Too Late to Improve Statin Adherence: Association Between Changes in Statin Adherence from Before to After Acute Myocardial Infarction and All‐Cause Mortality |
| title_fullStr | It's Not Too Late to Improve Statin Adherence: Association Between Changes in Statin Adherence from Before to After Acute Myocardial Infarction and All‐Cause Mortality |
| title_full_unstemmed | It's Not Too Late to Improve Statin Adherence: Association Between Changes in Statin Adherence from Before to After Acute Myocardial Infarction and All‐Cause Mortality |
| title_short | It's Not Too Late to Improve Statin Adherence: Association Between Changes in Statin Adherence from Before to After Acute Myocardial Infarction and All‐Cause Mortality |
| title_sort | it s not too late to improve statin adherence association between changes in statin adherence from before to after acute myocardial infarction and all cause mortality |
| topic | behavior change medication adherence myocardial infarction older adults secondary prevention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.011378 |
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