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August 22, 2019

Where do you live? It may determine how your heart attack is treated.

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    A patient's geographic region is strongly correlated with whether they receive a high-intensity statin after a heart attack, according to a study recently published in JAMA Cardiology.

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    Study details

    High-intensity statin therapy and moderate-intensity statin therapy are used to reduce levels of LDL-cholesterol in patients' blood, and Reuters reports that the therapies, on average, lead to a 50% reduction and 30% reduction, respectively.

    Vera Bittner, lead author of the study and section head of general cardiology, prevention and imaging at the University of Alabama, explained, "We know from clinical trials that individuals at high risk for a (heart attack or) who just had a (heart attack) ... do better with high-intensity statin therapy than with moderate-intensity statin therapy, and that moderate-intensity is better than no statin."

    However, prior research has indicated that high-intensity statin use often varies, and the latest study sought to determine which characteristics played the biggest role in that variation.

    For the study, the researchers looked at variation in post discharge use of high-intensity statins by geographic location, hospital characteristics such as size and type, and patient characteristics such as age, gender, and whether the patient received a stent. The researchers analyzed Medicare data from nearly 140,000 patients ages 66 and older who were hospitalized for myocardial infraction between Jan. 1, 2011, and June 30, 2015.  The researchers looked for high-intensity statin prescription claims within 30 days of discharge. 

    The study was supported by a research grant from drugmaker Amgen.

    Geography matters, study finds

    The researchers found that geography had a stronger association with high-intensity statin use than hospital or patient characteristics, according to Emily Levitan, associate professor for the Department of Epidemiology at the University of Alabama.

    Patients from New England were most likely to receive a high-intensity statin, while patients from the West South Central United States—which includes patients from Arkansas, Louisiana, and Oklahoma—were the least likely to receive the medication.

    The results also revealed that patients in smaller hospitals, or hospitals with fewer than 100 beds, were less likely to be prescribed a high-intensity statin than patients in hospitals with 500 or more beds. Women were also less likely than men to get high-intensity statins.

    Researchers don't know why geography plays such a big role

    The results of the new study reinforce previous research that shows that geographic regions with lower prescription rates for high-intensity statins also had the highest death rates for heart disease, according Suzanne Steinbaum, director of Women's Cardiovascular Prevention, Health and Wellness at Mount Sinai Hospital in New York. 

    Bittner said the researchers don't know why heart attack survivors from the central United States are less likely to receive high-intensity statins.  

    "Is it that physicians are less likely to prescribe these agents in some regions? Is it that patients are less likely to fill the prescriptions in some regions, or are there other factors we don't know about?" Bittner said. "It is also unlikely to be lack of access to information on the health care providers' part. … It is also not access to prescriptions because our population only included individuals with Medicare Part D prescription coverage."

    Until researchers can determine what's behind the discrepancy, Bittner said that hospitals in the United States should analyze their data on heart attack patients to detect discrepancies in statin prescriptions.

    "If they find underutilization, then they should develop treatment pathways designed to improve the treatment gap," Bittner said. It could be "something as simple as a checklist on discharge for patients with a (heart attack) that asks the clinician, 'Is this patient going home on a high-intensity statin?'" (Carroll, Reuters, 7/26; Pope, UAB News, 7/24).

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