Statin Use After Acute Myocardial Infarction by Patient Complexity

The aim of this study was to investigate the cost-effectiveness of statin use by newly hospitalised patients with acute myocardial infarction (AMI) in Finland. The data were from the PERFECT database of patients hospitalised for AMI and discharged in 1998–2012 in Finland. Selected patients had first-time AMI and had not used statins earlier (N=60 404). We generated a matched data set from statin non-users for statin users based on propensity matching analysis (N=28 412), which was also used. Statin use was defined as statins purchased within the first week after hospital discharge. Healthcare costs included costs of inpatient and outpatient hospital care, costs of nursing homes and costs of prescribed medicines (at 2011 prices). The follow-up time was one year. Logit and generalised linear models were used. We measured the effects of statin use as life years (LYs) gained and computed costs per LY gained. Both data were analysed for the entire period and for subperiods 1998–2001, 2002–2007 and 2008–2011, without discount rates and with a 3% discount rate. An average patient would gain 0.26–0.51 more years. The estimated costs per LY gained ranged between EUR 800 and 15 000. They were highest (EUR 12 000–15 000) in 1998–2001 by the matched data, but were actually savings in 2008–2011. The estimated costs indicate that statin use in treating AMI was very cost-effective. However, our rather long study period may suggest that the cost estimates per LY gained could be overestimated, as the life expectancy of AMI patients is likely shorter than that of the general population.Published: Online April 2018.

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Geographic Variation in Statin Use for Complex Acute Myocardial Infarction Patients

Medical Care ◽

10.1097/mlr.0b013e3182a7fc3d ◽

2014 ◽

Vol 52 ◽

pp. S37-S44 ◽

Cited By ~ 15

Author(s):

John M. Brooks ◽

Elizabeth A. Cook ◽

Cole G. Chapman ◽

Puttarin Kulchaitanaroaj ◽

Elizabeth A. Chrischilles ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Geographic Variation ◽

Statin Use

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Impact of statin use before the onset of acute myocardial infarction on coronary plaque morphology of the culprit lesion, inflammatory response, and viable myocardium

European Heart Journal ◽

10.1093/eurheartj/eht307.23 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. 23-23

Author(s):

H. Hikita ◽

T. Shigeta ◽

K. Kozima ◽

K. Hishikari ◽

Y. Oosaka ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Inflammatory Response ◽

Coronary Plaque ◽

Viable Myocardium ◽

Plaque Morphology ◽

Culprit Lesion ◽

Coronary Plaque Morphology ◽

Statin Use

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Abstract 17519: Exercise Capacity Increase, Obesity, and Statin Therapy Are the Key Factor for Decrease C-Reactive Protein through Exercise Training after Acute Myocardial Infarction

Circulation ◽

10.1161/circ.130.suppl_2.17519 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Takahito Doi ◽

Reon Kumasaka ◽

Tetsuo Arakawa ◽

Michio Nakanishi ◽

Teruo Noguchi ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Exercise Training ◽

Statin Therapy ◽

Exercise Capacity ◽

Linear Regression Analysis ◽

Hdl Cholesterol ◽

C Reactive Protein ◽

Reactive Protein ◽

Statin Use

Backgrounds: Cardiac rehabilitation with exercise training (CR/ET) has been reported to be associated with reduction in C-reactive protein (CRP) levels in patients with coronary artery disease. However, determinants of reduction in CRP through CR/ET after acute myocardial infarction (AMI) are not fully understood. Methods: We studied 490 consecutive AMI patients (age 63±11 years, male 83%) who participated in our CR/ET program and underwent measurements for serum CRP and peak oxygen uptake (PVO2) by symptom-limited cardiopulmonary exercise test at the beginning and the end of the 3-month CR program. Patients with abnormally high CRP (>= 20mg/L at baseline, >=10mg/L at 3 months) or on hemodialysis were excluded. Results: After the 3-month CR/ET, body mass index (BMI, 23.3 to 23.1, P<0.001) and CRP (4.7mg/L to 1.1mg/L, P<0.001) significantly decreased, and normalized PVO2 increased (77.4% to 84.9% P<0.001). The magnitude of changes in CRP (ΔCRP) were greater in patients with statin therapy than in patients without statin therapy (-2.9 +/- 0.4mg/L vs -3.9,+/- 0.3mg/L p<0.05). There were significant positive correlation between ΔCRP and HDL-cholesterol (r=0.14), and inverse correlations between ΔCRP and BMI (r=-0.09) and changes in %PVO2 (%ΔPVO2, r=-0.16). Multiple linear regression analysis (incorporating age, sex, baseline ejection fraction, BMI, Brain natriuretic peptide, Hemoglobin A1c, HDL-cholesterol, LDL-cholesterol, statin use, and %ΔPVO2) demonstrated that higher BMI, greater increase in PVO2, higher HDL-cholesterol, and statin use were the independent determinants (all p<0.05) of greater decrease in CRP. Diabetes and smoking status were not the independent determinants of CRP decrease. Conclusion: A greater increase in exercise capacity, in combination with obesity and statin use, significantly associated with a greater reduction in CRP in patients after AMI participating in CR/ET.

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Statin use after acute myocardial infarction: a nationwide study in Denmark

British Journal of Clinical Pharmacology ◽

10.1111/j.1365-2125.2005.02408.x ◽

2005 ◽

Vol 60 (2) ◽

pp. 150-158 ◽

Cited By ~ 26

Author(s):

Jeppe N. Rasmussen ◽

Gunnar H. Gislason ◽

Steen Z. Abildstrom ◽

Soren Rasmussen ◽

Ida Gustafsson ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Nationwide Study ◽

Statin Use

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Effect of Statin Use Within the First 24 Hours of Admission for Acute Myocardial Infarction on Early Morbidity and Mortality††A complete list of participating hospitals is available from ClinTrials Research, 1100 Weston Parkway, Cary, North Carolina 27513.

The American Journal of Cardiology ◽

10.1016/j.amjcard.2005.04.029 ◽

2005 ◽

Vol 96 (5) ◽

pp. 611-616 ◽

Cited By ~ 166

Author(s):

Gregg C. Fonarow ◽

R. Scott Wright ◽

Frederick A. Spencer ◽

Paul D. Fredrick ◽

Wei Dong ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

North Carolina ◽

Morbidity And Mortality ◽

Complete List ◽

Statin Use

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Effect of Statin Use Within the First 24 Hours of Admission for Acute Myocardial Infarction on Early Morbidity and Mortality

Yearbook of Cardiology ◽

10.1016/s0145-4145(07)70164-8 ◽

2006 ◽

Vol 2006 ◽

pp. 267-268

Author(s):

B.J. Gersh

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Morbidity And Mortality ◽

Statin Use

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Abstract 128: Adherence to Generic vs. Brand Statins among Older Patients After Acute Myocardial Infarction

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.128 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Emily C O'Brien ◽

Eric D Peterson ◽

Lisa A McCoy ◽

Laine Thomas ◽

Tracy Y Wang

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Medication Adherence ◽

Clinical Factors ◽

Post Discharge ◽

Statin Prescription ◽

Therapy Cost ◽

One Year ◽

Statin Adherence ◽

Statin Use

Background: Statins reduce mortality after acute myocardial infarction (MI), but up to half of patients discontinue statins within 1 year of starting therapy. Cost is one factor that may influence medication adherence, yet it is unknown whether use of generic vs. brand statin influences medication adherence. Methods: We linked detailed in-hospital clinical data for 1,421 NSTEMI patients discharged on a statin in 2006 to Medicare Part D medication claims records to examine post-discharge medication use. We excluded brand statin fills for which there were no generic dose equivalents. One-year statin adherence was defined as the proportion of days covered (PDC). We examined the association of brand vs. generic statin prescription and one-year adherence after adjusting for demographics, clinical factors, pre-discharge lipid values, prior statin use, and copay amount. Results: Overall, 65.5% of statin fills were for brand named statins. There were few baseline differences in demographics and clinical factors among generic vs. brand users. Patient copay amounts for generic statins (median=$5; IQR 1 - 10) were lower than those for brand statins (median=25; IQR 3 - 35). The mean PDC over one year was similar for brand users (71.5%; SD 31.2) and generic users (68.9%; STD 35.2%; p=0.97; unadjusted OR 1.15 [95% CI 0.96, 1.37]). Adherence remained non-significantly different between generic and brand statin users after adjusting for demographics, clinical risk factors, lipid value, prior statin use, and copay amount (Figure). Copay amount was not significantly associated with PDC (Per $ increase: OR=0.99 [95% CI 0.97, 1.01]; p=0.23). Conclusions: In a cohort of older NSTEMI patients, we found no evidence that adherence to statins one year after hospital discharge was improved among patients prescribed generic statins vs. brand statins.

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