Statin Adherence Lacking After Myocardial Infarction

Many patients have low adherence to statins more than 2 years after a heart attack.

Following a myocardial infarction, many patients are prescribed high-intensity statins. Despite the benefits from the therapy, a study published by JAMA Cardiology indicated that many patients did maintain high adherence to the treatment 2-years post-hospitalization for a heart attack.

The risk of experiencing a recurrent cardiovascular event after a myocardial infarction is high. Experiencing a recurrent event dramatically reduces survival and worsens patient outcomes. Statins are prescribed to reduce this risk.

Included in the study were 29,932 Medicare beneficiaries aged 66 to 75 and 27,956 beneficiaries older than 75 who were hospitalized for a myocardial infarction between 2007 and 2012. All patients included filled a prescription for high-intensity statins: atorvastatin, 40- to 80-mg, and rosuvastatin, 20- to 40-mg within 30 days of hospital discharge.

Among patients aged 66 to 75, 59% of patients were taking high-intensity statins with high adherence (a proportion of days covered of at least 80%) at 6 months. This number decreased to 42% at 2 years. At 6 months, 8.7% of patients switched to low/moderate-intensity statin, and 13% down titrated by 2 years, according to the study.

Additionally, 17% and 19% of patients had low adherence at 6 months and 2 years, respectively. A total of 12% and 19% of patients aged 66 to 75 discontinued treatment at 6 months and 2 years, respectively.

“Few beneficiaries taking statins with low adherence or who discontinued statin therapy at 6 months were taking high- or low/moderate-intensity statins with high adherence at 1 year, 18 months, and 2 years,” the authors wrote.

The authors also found that African American and Hispanic patients and new statin users were less likely to adhere to high-dose regimens, according to the study.

Patients with high adherence to high-intensity statins were more likely to be covered by both Medicare and Medicaid, visit the cardiologist more frequently, and participate in cardiac rehabilitation compared with those who had lower adherence.

The authors noted that these findings were consistent with previous studies that showed low co-payments, cardiology visits, and cardiac rehabilitation resulted in higher adherence to statins.

The authors discovered similar results among patients older than 75, according to the study.

These findings could be used to develop novel interventions to increase adherence to high-intensity statins, according to the study.

“Results from this study indicate that many patients who fill a high-intensity statin following an MI [myocardial infarction] hospitalization do not continue taking this medication with high adherence during the 2-years post-discharge,” the authors concluded. “Lower medication costs, cardiologist visits, and cardiac rehabilitation may contribute to improving high-intensity statin use and adherence after myocardial infarction.”