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 "Our theory is that the heart attack hospitalization appeared to
serve as a teachable moment, or a wake-up call, to patients to do
everything possible to prevent another heart attack," lead study
author Dr. Ian Kronish of Columbia University Medical Center said by
email.
Millions of people worldwide take statins to help reduce their blood
levels of low-density lipoprotein, or LDL, cholesterol – the bad
kind that builds up in blood vessels, damages artery walls and can
lead to clots and heart attacks.
The researchers studied more than 175,000 people age 65 or older
whose doctors had given them prescriptions for statins.
They divided the patients into three groups: 6,600 who were
hospitalized for a heart attack between 2007 and 2011, 11,000 who
were hospitalized during that period for pneumonia, and 158,000 who
weren’t hospitalized at all.
About a third of the heart attack patients had been skipping their
statins at least 20 percent of the time. Compared to non-adherent
patients who’d been hospitalized for pneumonia, the previously
non-adherent heart attack patients were 70 percent more likely to
take their pills more regularly after they left the hospital.
The study also looked at what happened to the opposite kind of
patients, that is, those who did take their statin medications
consistently before a hospital stay for a heart attack or pneumonia.
Overall, about one-third of these people started skipping doses
after going home from the hospital.
However, under these circumstances, people hospitalized for heart
attacks were about 7 percent less likely to curb statin use after
their stay than their peers treated for pneumonia, researchers
report in the journal Circulation: Cardiovascular Quality and
Outcomes.
But compared with people never hospitalized, these patients were 41
percent more likely to become less consistent in their use of daily
statins during the study period.
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One limitation of the study is that it used Medicare claims data for
drugs and hospital services, which doesn't always accurately reflect
what care patients receive or why, the authors note. Researchers
also limited their analysis to patients who survived at least six
months after their initial hospitalization, which may have weeded
out the sickest people or created a study population with an
inflated proportion of people who took their statins regularly.
Still, the results suggest that a heart attack hospitalization may
be an opportunity for doctors to assess whether patients are taking
statins as prescribed and motivate them to be more consistent in
sticking with their drug regimen, the authors conclude.
"The time after a heart attack is a vulnerable period for patients
both emotionally and physically," said Dr. Leslie Cho, head of
preventive cardiology at Cleveland Clinic in Ohio.
"For patients who were previously non-adherent to taking their
statins, they may now realize that it is something that they can do
to prevent future heart attacks," Cho, who wasn't involved in the
study, said by email.
On the other hand, if people took statins religiously and then had a
heart attack, they might get discouraged and decide not to be so
vigilant about these pills afterwards, Cho added.
"Patients who have had heart attacks need to recognize that statins
actually prevent not only (repeat hospitalizations) but death," Cho
said.
SOURCE: http://bit.ly/1XZTfgh Circulation: Cardiovascular Quality
and Outcomes, online May 24, 2016.
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