急性心肌梗死住院治疗对老年人他汀类药物依从性的影响。
Impact of Hospitalization for Acute Myocardial Infarction on Adherence to Statins Among Older Adults.
作者信息
Kronish Ian M, Ross Joseph S, Zhao Hong, Muntner Paul
机构信息
From the Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY (I.M.K.); Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT (J.S.R.); Department of Health Policy and Management, Yale University School of Public Health, New Haven, CT (J.S.R.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital (J.S.R.); and Department of Epidemiology, University of Alabama at Birmingham (H.Z., P.M.).
出版信息
Circ Cardiovasc Qual Outcomes. 2016 Jul;9(4):364-71. doi: 10.1161/CIRCOUTCOMES.115.002418. Epub 2016 May 24.
BACKGROUND
Little is known about the impact of hospitalization for an acute myocardial infarction (AMI) on subsequent adherence to statins.
METHODS AND RESULTS
Using administrative claims from a 5% random sample of Medicare beneficiaries, we identified a cohort of Medicare patients aged ≥65 years, hospitalized from 2007 to 2011, taking statins in the year before AMI hospitalization (n=6618). We then determined the proportion of patients nonadherent to statins (proportion of days covered <80%) in the year before AMI hospitalization who became statin adherent (proportion of days covered ≥80%) in the year after AMI hospitalization. The proportion of statin-adherent patients who became nonadherent was also studied. These proportions were compared with patients hospitalized for pneumonia (n=11 471) and patients not hospitalized (n=158 099) in 2010 and 2011. Among patients nonadherent to statins before AMI hospitalization, 37.7% became adherent after discharge. Patients hospitalized for AMI were more likely to become adherent than patients hospitalized for pneumonia (adjusted relative risk: 1.70; 95% confidence interval, 1.57-1.84) or patients not hospitalized (adjusted relative risk: 1.79; 95% confidence interval, 1.68-1.90). Among patients adherent to statins before AMI hospitalization, 32.6% became nonadherent after discharge. Those hospitalized for AMI were less likely to become nonadherent than those hospitalized for pneumonia (adjusted relative risk: 0.93; 95% confidence interval 0.88-0.98) but more likely to become nonadherent than patients without hospitalizations (adjusted relative risk: 1.41; 95% confidence interval, 1.35-1.48).
CONCLUSIONS
Among nonadherent patients, hospitalization for AMI was associated with increased likelihood of becoming adherent to statins compared with hospitalization for pneumonia or no hospitalizations. Among adherent patients, hospitalization for AMI was associated with increased likelihood of becoming nonadherent to statins compared with no hospitalizations.
背景
急性心肌梗死（AMI）住院治疗对后续他汀类药物依从性的影响鲜为人知。
方法与结果
利用从5%的医疗保险受益人随机样本中获取的管理索赔数据，我们确定了一组年龄≥65岁、在2007年至2011年期间住院、在AMI住院前一年服用他汀类药物的医疗保险患者（n = 6618）。然后我们确定了在AMI住院前一年他汀类药物不依从（覆盖天数比例<80%）的患者中，在AMI住院后一年变为他汀类药物依从（覆盖天数比例≥80%）的患者比例。还研究了他汀类药物依从患者变为不依从的比例。将这些比例与2010年和2011年因肺炎住院的患者（n = 11471）以及未住院的患者（n = 158099）进行比较。在AMI住院前他汀类药物不依从的患者中，37.7%在出院后变为依从。因AMI住院的患者比因肺炎住院的患者（调整后相对风险：1.70；95%置信区间，1.57 - 1.84）或未住院的患者（调整后相对风险：1.79；95%置信区间，1.68 - 1.90）更有可能变为依从。在AMI住院前他汀类药物依从的患者中，32.6%在出院后变为不依从。因AMI住院的患者比因肺炎住院的患者变为不依从的可能性小（调整后相对风险：0.93；95%置信区间0.88 - 0.98），但比未住院的患者变为不依从的可能性大（调整后相对风险：1.41；95%置信区间，1.35 - 1.48）。
结论
在不依从的患者中，与因肺炎住院或未住院相比，AMI住院与他汀类药物依从性增加的可能性相关。在依从的患者中，与未住院相比，AMI住院与他汀类药物不依从性增加的可能性相关。
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