Fewer than half of patients take high intensity statins two years after MIBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1956 (Published 21 April 2017) Cite this as: BMJ 2017;357:j1956
A substantial proportion of patients prescribed high intensity statins following a heart attack do not continue to regularly take them after they have been discharged from hospital, a study published in JAMA Cardiology has found.1
Risk of recurrent coronary heart disease events is high after a myocardial infarction. American Heart Association guidelines recommend that patients aged 75 or younger with coronary heart disease take high intensity statins. Among those older than 75 the guideline recommends moderate intensity statins, with high intensity statins considered reasonable for some older patients.
The retrospective cohort study included 29 932 patients aged 66 to 75 years and 27 956 patients older than 75 who had been hospitalised in the US for myocardial infarction. All the patients had Medicare fee-for-service coverage, including pharmacy benefits, and had been prescribed a high intensity statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg).
Six months after discharge from hospital 58.9% of the 66 to 75 year age group continued to take a high intensity statin with high adherence—meaning they took them on at least 80% of days. The results showed that 8.7% down titrated to a low or moderate intensity statin with high adherence; 17.3% had low statin adherence; and 12.4% discontinued their statin altogether. After two years only 42% continued to take the high intensity statins with high adherence.
The study found that African American patients, Hispanic patients, and new high intensity statin users were less likely to continue to take high intensity statins with high adherence. Those patients who had both Medicare and Medicaid coverage, had more cardiologist visits after discharge, and who participated in cardiac rehabilitation were more likely to take high intensity statins with high adherence. The results were similar in the over 75 year age group.