30% of heart patients still taking prescribed statins 3 years later

While 71 percent of heart patients are prescribed statins after hospitalization for heart disease, cerebrovascular disease and peripheral artery disease, just 37.4 percent retain that medication regimen a year later, researchers in Salt Lake City reported this week.

Due to their lipid-lowering qualities, statins are commonly prescribed to heart patients to keep cardiac complications at bay, and are widely recommended across the globe. Still, around 30 percent of cardiac patients leave the hospital without a prescription for the medication, J. Brent Muhlestein, MD, and colleagues found—and that fact could be complicating future care.

“Earlier studies had proven that a strong predictor of how well patients did in the long-term was whether they were discharged from the hospital on a statin medicine,” Muhlestein said in a release from the Intermountain Medical Center Heart Institute.

Muhlestein and his team analyzed the health records of 62,070 patients discharged for cardiovascular, cerebrovascular or peripheral artery disease between 1999 and 2013. Each participant was followed for at least three years or until their death.

The major fall from initial statin prescription to continued use one year later was surprising to the researchers given the health benefits of statins, including lowering cholesterol and reducing a patient’s risk of another trip to the emergency room. But, year after year, the numbers continued to fall. Three years after the study group’s initial heart events, just 30.1 percent were still taking statins.

Intermountain Healthcare established a hospital-based discharge medication program in 1999 that ensured cardiac patients had access to a statin prescription post-hospitalization.

“By implementing this program and discharging patients on statins, we were able to see a significant reduction in repeat hospitalizations and mortality over the next year,” Muhlestein said.

The researchers found the strongest predictor of changing a statin routine was wellness—a surprise to Muhlestein. He said patients were more likely to stop taking statins if they had a clean bill of health; those who’d had a repeat heart attack, for instance, were more likely to still be taking the drugs.

LDL cholesterol screenings seemed to play a part, too, he said. If a doctor had ordered an additional cholesterol screening after prescribing a patient statins, that patient was statistically three times more likely to stay on that medication regimen.

Insured individuals were also more likely to stick with their statin schedule. Patients paying for the drugs out of pocket had a harder time staying on the medication.

“We need to find a better class of drugs,” Muhlestein said. “Researchers are working on that—testing a new class of drugs called PCSK9 inhibitors, which have the potential for filling that treatment gap because they have, as of yet, no identified side-effects.”

While PCSK9 inhibitors have proven successful in initial trials, the cost of the medication is of huge concern to many U.S. patients.

Muhlestein said other options for remedying the gap are expanding discharge medication protocol from hospitals to physician clinics to track statin prescription and compliance, and further education about the medication’s benefits to patients. He presented his research at the 2017 American Heart Association Scientific Sessions in Anaheim, California, this week.