Booth John N, Colantonio Lisandro D, Chen Ligong, Rosenson Robert S, Monda Keri L, Safford Monika M, Kilgore Meredith L, Brown Todd M, Taylor Benjamin, Dent Ricardo, Muntner Paul, Levitan Emily B
From the Department of Epidemiology (J.N.B., L.D.C., L.C., P.M., E.B.L.), Department of Health Care Organization and Policy (M.L.K.), and Department of Medicine (T.M.B), University of Alabama at Birmingham, AL; Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY (R.S.R.); Center for Observational Research (K.L.M., B.T.) and Global Development (R.D.), Amgen Inc., Thousand Oaks, CA; and Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.).
From the Department of Epidemiology (J.N.B., L.D.C., L.C., P.M., E.B.L.), Department of Health Care Organization and Policy (M.L.K.), and Department of Medicine (T.M.B), University of Alabama at Birmingham, AL; Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY (R.S.R.); Center for Observational Research (K.L.M., B.T.) and Global Development (R.D.), Amgen Inc., Thousand Oaks, CA; and Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.)
Circ Cardiovasc Qual Outcomes. 2017 Oct;10(10). doi: 10.1161/CIRCOUTCOMES.117.003626.
Although the benefits of statins accrue over time, treatment discontinuation is common. Examining the patterns of statin discontinuation, reinitiation, and persistence after reinitiation among Medicare beneficiaries after hospital discharge for a myocardial infarction may help increase statin use in high-risk patients.
Medicare beneficiaries with a statin fill claim within 30 days after hospital discharge for myocardial infarction in 2007 to 2012 (n=158 795) were followed for 182 days post-discharge to identify discontinuation, defined as 60 continuous days without statins available. Reinitiation, defined by a statin fill, was identified in the 365 days post-discontinuation. High persistence was defined as proportion of days covered ≥80% with ≥1 day of statin supply 182 days after reinitiation. Follow-up ended on December 31, 2014. In the 182 days after myocardial infarction hospital discharge, 15.4% of beneficiaries discontinued statins. Of this group, 53.7% reinitiated statins. On reinitiation, 27.1% changed statin type, 6.9% up-titrated intensity, 14.4% down-titrated intensity, and 66.0% had the same statin and intensity. In the 182 days after reinitiation, 45.8% had high persistence. Moderate- and high- versus low-intensity statins were associated with a lower risk for statin discontinuation (moderate intensity: relative risk [RR], 0.93; 95% confidence interval [CI], 0.89-0.96; high-intensity: RR, 0.95; 95% CI, 0.91-0.99). High persistence was less common after reinitiating high- versus low-intensity statins (RR, 0.80; 95% CI, 0.75-0.86), but no association was present for those reinitiating a moderate- versus low-intensity statin (RR, 0.95; 95% CI, 0.90-1.01). Down-titrating versus reinitiating the same statin intensity (RR, 1.10; 95% CI, 1.05-1.16) and reinitiating a different versus the same statin (RR, 1.10; 95% CI, 1.06-1.14) were associated with high persistence after treatment reinitiation.
Although many people who discontinue a statin reinitiate treatment, statin persistence after reinitiation was low. Reinitiating therapy with moderate-intensity statins, down-titration, and using a different statin may promote persistence.
尽管他汀类药物的益处会随着时间积累，但治疗中断的情况很常见。研究心肌梗死出院后医疗保险受益人中他汀类药物中断、重新开始使用以及重新开始使用后的持续用药模式，可能有助于提高高危患者的他汀类药物使用率。
对2007年至2012年因心肌梗死出院后30天内有他汀类药物配药记录的医疗保险受益人（n = 158795）进行出院后182天的随访，以确定中断用药情况，中断用药定义为连续60天没有他汀类药物可用。在中断用药后的365天内确定重新开始用药情况，重新开始用药定义为有他汀类药物配药记录。高持续用药率定义为重新开始用药182天后，他汀类药物供应≥1天且覆盖天数比例≥80%。随访于2014年12月31日结束。在心肌梗死出院后的182天内，15.4%的受益人中断了他汀类药物治疗。在这组人群中，53.7%重新开始使用他汀类药物。重新开始用药时，27.1%的人更换了他汀类药物类型，6.9%的人增加了用药强度，14.4%的人降低了用药强度，66.0%的人使用相同的他汀类药物和强度。在重新开始用药后的182天内，45.8%的人有高持续用药率。中等强度和高强度他汀类药物与较低的他汀类药物中断风险相关（中等强度：相对风险[RR]，0.93；95%置信区间[CI]，0.89 - 0.96；高强度：RR，0.95；95% CI，0.91 - 0.99）。重新开始使用高强度与低强度他汀类药物后高持续用药率不太常见（RR，0.80；95% CI，0.75 - 0.86），但重新开始使用中等强度与低强度他汀类药物的人群中不存在这种关联（RR，0.95；95% CI，0.90 - 1.01）。与重新开始使用相同他汀类药物强度相比，降低用药强度（RR，1.10；95% CI，1.05 - 1.16）以及重新开始使用不同与相同他汀类药物（RR，1.10；95% CI，1.06 - 1.14）与重新开始治疗后的高持续用药率相关。
尽管许多中断他汀类药物治疗的人会重新开始治疗，但重新开始用药后的他汀类药物持续用药率较低。重新开始使用中等强度他汀类药物、降低用药强度以及使用不同的他汀类药物可能会提高持续用药率。
