A new study raises the question of what to do if patients don’t take the drugs, however. The problem isn’t just initiation—past research indicates that fewer than 30% of Medicare beneficiaries aged 65 to 74 years filled a high-intensity statin prescription within 90 days after a coronary heart disease–related hospitalization—but continued adherence by those patients who actually start taking the cholesterol-lowering drugs, according to a new report in JAMA Cardiology.
The study, led by Icahn School of Medicine at Mount Sinai researchers, found that after 2 years, fewer than half of the patients still had optimal adherence to high-intensity statins.
Researchers focused on Medicare beneficiaries who had been hospitalized for MI between 2007 and 2012—including 30,000 Medicare beneficiaries aged 66 to 75 years, and nearly 28,000 patients older than 75 years—who filled a high-intensity statin prescription, either atorvastatin, 40 mg–80 mg, or rosuvastatin, 20 mg–40 mg, within 30 days of discharge.
Even though all the fee-for-service Medicare beneficiaries had pharmacy benefits, adherence to high-intensity statins dropped within 6 months, and again within 2 years.
Results indicate that 59% of the younger cohort had high adherence, defined as usage more than 80% of the time, after 6 months and 42% were still regularly taking the drugs 2 years after discharge. Some of the patients—8.7% by 6 months and 13% by 2 years—had switched to a low/moderate intensity statin but remained highly adherent.
Of the remaining patients, 17% at 6 months and 19% at 2 years had low adherence, defined as a proportion of days covered less than 80% for any statin intensity without discontinuation, while 12% and 19% discontinued their statins after 6 months and 2 years, respectively. Study authors said similar results were recorded with the older cohort.
Less likely to maintain strong adherence to high-intensity statins were African American and Hispanic patients and those in whom the drugs had recently been initiated, according to the report. More likely to follow their drug regimen, on the other hand, were patients with dual Medicare/Medicaid coverage and more cardiologist visits after discharge, as well as those who participated in cardiac rehabilitation.
Overall, researchers report, the proportion taking high-intensity statins with high adherence rates increased between 2007 and 2012.
In an effort to continue that trend, they said, “Lower medication costs, cardiologist visits, and cardiac rehabilitation may contribute to improving high intensity statin use and adherence after myocardial infarction.”
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