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

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.

SUBMITTER: Boklage SH

PROVIDER: S-EPMC6018577 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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

Boklage Susan H SH Malangone-Monaco Elisabetta E Lopez-Gonzalez Lorena L Ding Yao Y Henriques Caroline C Elassal Joseph J

Cardiovascular drugs and therapy 20180601 3

<h4>Purpose</h4>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 outco ...[more]

PMID: 29855748

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Project description:BackgroundConsequences of reduced acute coronary syndrome (ACS) admissions during COVID-19 pandemic periods were reported by different countries. However, admissions, treatments, and prognosis of ACS during and after COVID-19 pandemic in Beijing, China was unknown.MethodsInformation on ACS admissions and heart failure (HF) admission were identified from database of Beijing Municipal Health Commission Information Center. Study period was defined as December 1, 2019 to June 30, 2020, and control period was defined as December 1, 2018 to June 30, 2019. Numbers of admission for HF during the control period, the study period, and seven months after study period were compared to evaluate the consequence of changed ACS care during the COVID-19 pandemic.FindingsAdmissions for ST-elevation myocardial infarction (STEMI), Non-ST-elevation myocardial infarction (Non-STEMI), and unstable angina (UAP) reduced by 38·0%, 41·0%, and 63·3% (N = 1953, 1991, 7664 between January 24, 2020 to June 30, 2020 vs. N = 3150, 3373, and 20,868 between January 24, 2019 to June 30, 2019) in study period. Percutaneous coronary intervention performed within 24 h were significantly more frequent during study period in patients with STEMI (37·9% vs. 31·7%, P<0·0001), but significantly less frequent in patients with Non-STEMI (7·9% vs. 9·5%, P = 0·049), and in patients with UAP (1·7% vs. 3·5%, P<0·0001). In-hospital mortality rates in patients with ACS were similar during the study period and the control period (3·1% vs 2·5%, P = 0·174 for STEMI; 2·7% vs 2·3%, P = 0·429 for Non-STEMI; 0·2% vs 0·1%, P = 0·222 for UAP). A fall by 23.9% for HF admissions was also observed during the seven months following the study period than equivalent period in 2019.InterpretationDuring COVID-19 pandemic, ACS admissions reduced significantly in Beijing; however, increase of HF admissions was not observed within seven months post-pandemic period, implying the pandemic didn't deteriorate the short-term prognosis for ACS.Fundingthe National Natural Science Foundation of China (82,103,904), the National Key Research and Development Program of China (Grant number: 2020YFC2004803).

Project description:It is important that actual outcomes of care and not surrogate markers, such as process measures, be used to evaluate the quality of inpatient care. Because of the heterogenous composition of patients, risk-adjustment is essential for the objective evaluation of outcomes following inpatient care. Comparative evaluation of risk-adjusted outcomes can be used to identify suboptimal performance and can provide direction for care improvement initiatives.We studied the risk-adjusted outcomes of 6 medical conditions during the inpatient and 90-day post-discharge period to identify the opportunities for care improvement. The Medicare Limited Dataset for 2012 to 2014 was used to identify acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), pneumonia (PNEU), cerebrovascular accidents (CVA), and gastrointestinal hemorrhage (GIH). Stepwise logistic predictive models were developed for the adverse outcomes (AOs) of inpatient deaths, 3-sigma prolonged length-of-stay outliers, 90-day post-discharge deaths, and 90-day readmissions after unrelated events were excluded. Observed and predicted AOs were determined for each hospital with ?75 cases for each of the 6 medical conditions. Z-scores and risk-adjusted AO rates for each hospital permitted comparative analysis of outcomes after adjusting for covariance among the medical conditions.There were a total of 1,811,749 patients from 973 acute care hospitals with the 6 medical conditions. A total of 41% of all patients had ?1 AO events. One or more readmissions were identified in 29.8% of patients. A total of 64 hospitals (6.4%) were 2 standard deviations better than the mean for risk-adjusted outcomes, and 72 (7.4%) were 2 standard deviations poorer. The best performing decile of hospitals had mean AO rates of 35.1% (odds ratio?=?0.766; 95% confidence interval (CI) CI: 0.762-0.771) and the poorest performing decile a mean AO rate of 48.5% (odds ratio?=?1.357; 95% CI: 1.346-1.369). Volume of qualifying cases ranged from 670 to 9314; no association was identified for increased volume of patients (P?<?.40).Risk-adjusted AO rates demonstrated nearly a 14% opportunity for care improvement between top and suboptimal performing hospitals. Hospitals must be able to benchmark objective measurement of outcomes to inform quality initiatives.

Project description:BackgroundAcute coronary syndrome continues to be a significant cardiovascular issue. Statins are commonly acknowledged as medications that reduce LDL-C levels and stabilize plaques. Nevertheless, their efficacy is limited. Presently, PCSK9 inhibitors are suggested to be advantageous in patients who are already receiving statin treatment. The study seeks to assess the safety and effectiveness of PCSK9 inhibitors in individuals who have been treated with statins after experiencing acute coronary syndrome (ACS), as well as investigate the impact on the characteristics of coronary plaque.MethodsArticles were identified from PubMed, Cochrane Central Register of Controlled Trials, and ProQuest. Our analysis comprised trials and observational studies that compared the plaque phenotype, lipid profile, and safety outcomes between PCSK9 inhibitors and a control group in patients with acute coronary syndrome who were already being treated with statins. The random-effect model was used to measure the pooled effect, which was presented in terms of mean difference, standardized mean difference, and risk ratio.ResultsAcquired 12 studies that fulfilled our criteria. The addition of PCSK9 inhibitors ameliorates the plaque phenotype significantly in terms of percent atheroma volume (P = 0.02), total atheroma volume (P < 0.010), fibrous cap thickness (P < 0.00001), lipid arc (P < 0.00001), quantitative flow ratio (P = 0.003), and diameter of stenosis (P = 0.0003) but not in lipid/lesion length (P = 0.17). The administration of PCSK9 inhibitors led to a considerable improvement in all lipid profiles (P < 0.00001). Regarding safety analysis, there is no substantial disparity in the likelihood of non-serious side events (RR 1.21; P = 0.2), however, a significant reduction in the risk of serious adverse effects (RR 0.77; P = 0.04) in the PCSK9 inhibitor group.ConclusionsThe addition of PCSK9 inhibitors compared to statin-only treatment led to a majority of patients experiencing significant benefits in terms of safety and efficacy following ACS.

Dataset Information

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

Publications

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

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