Missed opportunities in the secondary prevention of myocardial infarction: an assessment of the effects of statin underprescribing on mortality

American Heart Journal
Peter C AustinJack V Tu

Abstract

The benefits of statins for the secondary prevention of coronary heart disease are well established. Previous research indicates that patients at the greatest risk of cardiovascular events are the least likely to receive statins. We explored the potential reduction in mortality at the population level that could result from improving statin prescribing among patients least likely to be prescribed a statin after acute myocardial infarction (AMI). Simulation analysis of detailed clinical data for a population-based sample of 7285 AMI survivors discharged from 102 hospitals between April 1, 1999, and March 31, 2001 in Ontario, Canada, was done. Using estimates obtained from randomized controlled trials, we estimated the reduction in 3-year all-cause mortality associated with improved statin prescribing at hospital discharge. Overall, 35.6% of patients received a statin prescription at hospital discharge. We estimate that increasing statin prescribing among patients least likely to receive them (ie, the lowest quintile of propensity to receive a prescription at discharge) from the current rate of 7.8% to the rate among all patients (35.6%) could decrease AMI mortality by 83 deaths in Ontario per year (2.1% of all post-AMI deaths wi...Continue Reading

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Citations

Dec 4, 2010·Vascular Health and Risk Management·David ZakimM Dominik Alscher
Oct 10, 2014·Preventing Chronic Disease·Marta A Miyares, Kyle A Davis
Jul 16, 2008·Journal of Clinical Epidemiology·Peter C Austin
May 13, 2008·Journal of Clinical Epidemiology·Peter C Austin
Mar 26, 2009·Pharmacoepidemiology and Drug Safety·Peter C Austin, Douglas S Lee
Nov 21, 2008·Journal of Evaluation in Clinical Practice·Alan J ZillichThomas S Inui
Nov 21, 2008·Journal of Evaluation in Clinical Practice·Andrew MilesAndreas Polychronis
Oct 15, 2011·Journal of the American College of Cardiology·Apurva A MotivalaGregg C Fonarow
Jul 1, 2008·Journal of Vascular Surgery·Mohammed Al-OmranUNKNOWN Systematic Assessment of Vascular Risk Investigators
Jul 29, 2008·Archives of Cardiovascular Diseases·Jacques AmarNicolas Danchin
Oct 30, 2013·Circulation·Jerome L FlegUNKNOWN American Heart Association Committees on Older Populations and Exercise Cardiac Rehabilitation and Prevention of the Council

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