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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2018
Materias:	case‐crossover discontinuation re‐initiation statin statin discontinuation statin re‐initiation Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/33bb62b12a4b4076aa463cd67b294eda
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spelling	oai:doaj.org-article:33bb62b12a4b4076aa463cd67b294eda2021-11-12T17:02:02ZHealthcare Utilization and Statin Re‐Initiation Among Medicare Beneficiaries With a History of Myocardial Infarction10.1161/JAHA.117.0084622047-9980https://doaj.org/article/33bb62b12a4b4076aa463cd67b294eda2018-05-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.117.008462https://doaj.org/toc/2047-9980BackgroundContact 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.John N. BoothLisandro D. ColantonioRobert S. RosensonMonika M. SaffordLigong ChenMeredith L. KilgoreTodd M. BrownBenjamin TaylorRicardo DentKeri L. MondaPaul MuntnerEmily B. LevitanWileyarticlecase‐crossoverdiscontinuationre‐initiationstatinstatin discontinuationstatin re‐initiationDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 7, Iss 10 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	case‐crossover discontinuation re‐initiation statin statin discontinuation statin re‐initiation Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	case‐crossover discontinuation re‐initiation statin statin discontinuation statin re‐initiation Diseases of the circulatory (Cardiovascular) system RC666-701 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
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.
format	article
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
title	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_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_sort	healthcare utilization and statin re‐initiation among medicare beneficiaries with a history of myocardial infarction
publisher	Wiley
publishDate	2018
url	https://doaj.org/article/33bb62b12a4b4076aa463cd67b294eda
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Healthcare Utilization and Statin Re‐Initiation Among Medicare Beneficiaries With a History of Myocardial Infarction

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