BACKGROUND: Intensive statins are superior to moderate statins in reducing morbidity and mortality after an acute myocardial infarction. Although studies have documented rates of statin prescription as a quality performance measure, variations in hospitals' rates of initiating, intensifying, and maximizing statin therapy after acute myocardial infarction are unknown. METHODS AND RESULTS: We assessed statin use at admission and discharge among 4340 acute myocardial infarction patients from 24 US hospitals (2005-2008). Hierarchical models estimated site variation in statin initiation in naïve patients, intensification in those undergoing submaximal therapy, and discharge on maximal therapy (defined as a statin with expected low-density lipoprotein cholesterol lowering ≥ 50%) after adjustment for patient factors, including low-density lipoprotein cholesterol level. Site variation was explored with a median rate ratio, which estimates the relative difference in risk ratios of 2 hypothetically identical patients at 2 different hospitals. Among statin-naïve patients, 87% without a contraindication were prescribed a statin, with no variability across sites (median rate ratio, 1.02). Among patients who arrived on submaximal statins, 26% had their statin therapy intensified, with modest site variability (median rate ratio, 1.47). Among all patients without a contraindication, 23% were discharged on maximal statin therapy, with substantial hospital variability (median rate ratio, 2.79). CONCLUSIONS: In a large, multicenter acute myocardial infarction cohort, statin therapy was begun in nearly 90% of patients during hospitalization, with no variability across sites; however, rates of statin intensification and maximization were low and varied substantially across hospitals. Given that more intense statin therapy is associated with better outcomes, changing the existing performance measures to include the intensity of statin therapy may improve care.
BACKGROUND: Intensive statins are superior to moderate statins in reducing morbidity and mortality after an acute myocardial infarction. Although studies have documented rates of statin prescription as a quality performance measure, variations in hospitals' rates of initiating, intensifying, and maximizing statin therapy after acute myocardial infarction are unknown. METHODS AND RESULTS: We assessed statin use at admission and discharge among 4340 acute myocardial infarctionpatients from 24 US hospitals (2005-2008). Hierarchical models estimated site variation in statin initiation in naïve patients, intensification in those undergoing submaximal therapy, and discharge on maximal therapy (defined as a statin with expected low-density lipoprotein cholesterol lowering ≥ 50%) after adjustment for patient factors, including low-density lipoprotein cholesterol level. Site variation was explored with a median rate ratio, which estimates the relative difference in risk ratios of 2 hypothetically identical patients at 2 different hospitals. Among statin-naïve patients, 87% without a contraindication were prescribed a statin, with no variability across sites (median rate ratio, 1.02). Among patients who arrived on submaximal statins, 26% had their statin therapy intensified, with modest site variability (median rate ratio, 1.47). Among all patients without a contraindication, 23% were discharged on maximal statin therapy, with substantial hospital variability (median rate ratio, 2.79). CONCLUSIONS: In a large, multicenter acute myocardial infarction cohort, statin therapy was begun in nearly 90% of patients during hospitalization, with no variability across sites; however, rates of statin intensification and maximization were low and varied substantially across hospitals. Given that more intense statin therapy is associated with better outcomes, changing the existing performance measures to include the intensity of statin therapy may improve care.
Authors: Suzanne V Arnold; John A Spertus; Fengming Tang; Harlan M Krumholz; William B Borden; Steven A Farmer; Henry H Ting; Paul S Chan Journal: Circulation Date: 2011-11-07 Impact factor: 29.690
Authors: Neil J Stone; Jennifer G Robinson; Alice H Lichtenstein; C Noel Bairey Merz; Conrad B Blum; Robert H Eckel; Anne C Goldberg; David Gordon; Daniel Levy; Donald M Lloyd-Jones; Patrick McBride; J Sanford Schwartz; Susan T Shero; Sidney C Smith; Karol Watson; Peter W F Wilson; Karen M Eddleman; Nicole M Jarrett; Ken LaBresh; Lev Nevo; Janusz Wnek; Jeffrey L Anderson; Jonathan L Halperin; Nancy M Albert; Biykem Bozkurt; Ralph G Brindis; Lesley H Curtis; David DeMets; Judith S Hochman; Richard J Kovacs; E Magnus Ohman; Susan J Pressler; Frank W Sellke; Win-Kuang Shen; Sidney C Smith; Gordon F Tomaselli Journal: Circulation Date: 2013-11-12 Impact factor: 29.690
Authors: P Michael Ho; John A Spertus; Frederick A Masoudi; Kimberly J Reid; Eric D Peterson; David J Magid; Harlan M Krumholz; John S Rumsfeld Journal: Arch Intern Med Date: 2006-09-25
Authors: Suzanne V Arnold; Paul S Chan; Philip G Jones; Carole Decker; Donna M Buchanan; Harlan M Krumholz; P Michael Ho; John A Spertus Journal: Circ Cardiovasc Qual Outcomes Date: 2011-07
Authors: James A de Lemos; Michael A Blazing; Stephen D Wiviott; Eldrin F Lewis; Keith A A Fox; Harvey D White; Jean-Lucien Rouleau; Terje R Pedersen; Laura H Gardner; Robin Mukherjee; Karen E Ramsey; Joanne Palmisano; David W Bilheimer; Marc A Pfeffer; Robert M Califf; Eugene Braunwald Journal: JAMA Date: 2004-08-30 Impact factor: 56.272
Authors: Christopher P Cannon; Eugene Braunwald; Carolyn H McCabe; Daniel J Rader; Jean L Rouleau; Rene Belder; Steven V Joyal; Karen A Hill; Marc A Pfeffer; Allan M Skene Journal: N Engl J Med Date: 2004-03-08 Impact factor: 91.245
Authors: Alanna M Chamberlain; Sarah S Cohen; Jill M Killian; Keri L Monda; Susan A Weston; Ted Okerson Journal: Am J Cardiol Date: 2019-07-15 Impact factor: 2.778
Authors: Ankur Pandya; Stephen Sy; Sylvia Cho; Sartaj Alam; Milton C Weinstein; Thomas A Gaziano Journal: Med Decis Making Date: 2017-05-10 Impact factor: 2.583
Authors: Rebecca Vigen; John A Spertus; Thomas M Maddox; P Michael Ho; Philip G Jones; Suzanne V Arnold; Frederick A Masoudi; Steven M Bradley Journal: Circ Cardiovasc Qual Outcomes Date: 2014-11-11
Authors: Dylan L Steen; Irfan Khan; Laura Becker; JoAnne M Foody; Katherine Gorcyca; Robert J Sanchez; Robert P Giugliano Journal: Clin Cardiol Date: 2016-12-27 Impact factor: 2.882
Authors: Yevgeniy Khariton; Krishna K Patel; Paul S Chan; Yashashwi Pokharel; Jingyan Wang; John A Spertus; David M Safley; William R Hiatt; Kim G Smolderen Journal: Clin Cardiol Date: 2018-10-19 Impact factor: 2.882
Authors: Fatima Rodriguez; David J Maron; Joshua W Knowles; Salim S Virani; Shoutzu Lin; Paul A Heidenreich Journal: JAMA Cardiol Date: 2019-03-01 Impact factor: 14.676
Authors: Lihua Zhang; Jing Li; Xi Li; Khurram Nasir; Haibo Zhang; Yongjian Wu; Shuang Hu; Qing Wang; Nicholas S Downing; Nihar R Desai; Frederick A Masoudi; John A Spertus; Harlan M Krumholz; Lixin Jiang Journal: PLoS One Date: 2016-04-08 Impact factor: 3.240