In:
Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 5, No. suppl_1 ( 2012-04)
Abstract:
Background: Intensive statin therapy after an acute myocardial infarction (AMI) has been shown, in multiple trials, to be superior to less intensive treatment. Several studies have documented rates of statin prescription at discharge, in any dose, as a quality performance measure. However, variations in hospitals’ rates of initiating, intensifying and maximizing statin therapy after AMI are unknown. Methods: We assessed statin therapy at admission and discharge among 4340 AMI patients from 24 US hospitals (4/05-12/08). Initiation was defined as statin prescription at discharge in patients not admitted on them. Intensification reflected an increase in dose or change to a higher potency statin at discharge. The use of atorvastatin 80 mg or rosuvastatin 40 mg at discharge were considered maximal statin therapy. Hierarchical modified Poisson models estimated the association of site with initiation in naïve patients, intensification in those who arrived on submaximal therapy, and discharge on maximal therapy among all patients, after adjustment for patient factors including LDL level. Site variation was explored with a median rate ratio (MRR), which estimates the average relative difference in risk ratios of 2 hypothetically identical patients treated at 2 different sites. Results: On admission, 34.8% (1510/4340) of patients were taking a statin and 2.6% (112/4340) were on maximal therapy. 86.9% (2411/2776) of statin naïve patients without a contraindication were prescribed a statin at discharge, with no variability across sites after adjustment for patient factors (MRR 1.02). Among patients who arrived on submaximal statin therapy, 26.3% (323/1230) had their statin therapy intensified at discharge with modest site variability (MRR 1.47). Among all patients without a contraindication, 21.0% (899/4271) were discharged on maximal therapy with substantial site variability (MRR 2.79). Conclusions: In a large, multicenter AMI cohort, nearly all patients were started on statins during hospitalization, with no variability across sites. However, rates of statin intensification and maximization were lower and varied substantially across hospitals. Given that more intense statin therapy is important in optimizing outcomes, evolving the existing performance measures to include the intensity of statin therapy may be beneficial in improving care.
Type of Medium:
Online Resource
ISSN:
1941-7713
,
1941-7705
DOI:
10.1161/circoutcomes.5.suppl_1.A274
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2012
detail.hit.zdb_id:
2453882-6
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