TABLE 1.
Medicare Acute Myocardial Infarction (AMI) Patient Characteristics 2008–2009 by Initial Statin Intensity and Local Area No-Statin Prescribing Style
| Statin Use |
Quintiles of Local Areas
Based on “No-Statin” Use (Local Areas With Lower Statin
Use) |
||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Total Population | None | Lower Intensity | High Intensity | P | 1st | 2nd | 3rd | 4th | 5th | P† | |
| N | 124,813 | 47,566 | 62,316 | 14,931 | 24,962 | 24,960 | 24,966 | 24,958 | 24,967 | ||
| No-statin area treatment ratio‡ | * | * | * | * | 0.869 | 0.949 | 0.998 | 1.05 | 1.13 | ||
| Treatment | <0.0001* | ||||||||||
| No statin (%) | 38.1 | 100.0 | 0.0 | 0.0 | 32.4 | 36.1 | 37.8 | 40.6 | 43.6 | <0.0001* | |
| Lower intensity statin§ (%) | 49.9 | 0.0 | 100.0 | 0.0 | 52.4 | 51.0 | 50.2 | 49.0 | 47.1 | <0.0001* | |
| High-intensity statin§ (%) | 12.0 | 0.0 | 0.0 | 100.0 | 15.2 | 12.9 | 11.9 | 10.5 | 9.3 | <0.0001* | |
| Age | |||||||||||
| 66–75 (%) | 40.7 | 33.1 | 43.9 | 51.8 | <0.0001* | 38.8 | 40.8 | 40.8 | 41.0 | 42.3 | <0.0001* |
| 76–85 (%) | 38.6 | 38.7 | 39.0 | 36.6 | 0.0033* | 39.2 | 38.4 | 38.9 | 38.2 | 38.1 | 0.0139* |
| 86+ (%) | 20.7 | 28.2 | 17.1 | 11.6 | <0.0001* | 22.0 | 20.7 | 20.3 | 20.8 | 19.6 | <0.0001* |
| Sex | <0.0001* | 0.0144* | |||||||||
| Male (%) | 43.2 | 39.7 | 44.6 | 48.5 | 42.6 | 43.4 | 43.0 | 42.9 | 44.1 | ||
| Female (%) | 56.8 | 60.3 | 55.4 | 51.5 | 57.4 | 56.6 | 57.0 | 57.1 | 55.9 | ||
| Race | |||||||||||
| White (%) | 83.0 | 83.0 | 83.2 | 82.0 | 0.1135 | 78.4 | 84.2 | 83.7 | 85.5 | 83.2 | <0.0001* |
| Black (%) | 7.9 | 8.6 | 7.3 | 7.8 | <0.0001* | 10.2 | 7.9 | 8.1 | 7.1 | 6.1 | <0.0001* |
| Other/missing (%) | 9.1 | 8.4 | 9.5 | 10.2 | <0.0001* | 11.4 | 8.0 | 8.3 | 7.4 | 10.7 | 0.0011* |
| Complex conditions | |||||||||||
| Heart failure | 53.4 | 60.9 | 49.3 | 46.7 | <0.0001* | 56.3 | 52.9 | 53.2 | 53.1 | 51.4 | <0.0001* |
| Chronic kidney disease | 35.0 | 39.3 | 32.6 | 31.4 | <0.0001* | 36.4 | 35.3 | 35.2 | 34.6 | 33.5 | <0.0001* |
| Diabetes | 43.4 | 43.9 | 43.0 | 43.4 | 0.0043* | 44.6 | 42.5 | 43.4 | 43.6 | 42.7 | 0.0065* |
| Charlson Score‖ | <0.0001* | <0.0001* | |||||||||
| 0 (%) | 33.4 | 28.3 | 36.2 | 38.3 | 32.2 | 33.6 | 33.3 | 33.7 | 34.3 | ||
| 1+ (%) | 66.6 | 71.7 | 63.8 | 61.7 | 67.8 | 66.4 | 66.7 | 66.3 | 65.7 | ||
| Arterial wall AMI¶ (%) | 6.1 | 4.4 | 6.8 | 8.7 | <0.0001* | 5.9 | 6.4 | 6.0 | 6.2 | 6.2 | 0.2987 |
| NSTEMI AMI# (%) | 75.9 | 79.7 | 74.4 | 69.7 | <0.0001* | 77.7 | 75.8 | 75.7 | 75.2 | 75.0 | <0.0001* |
| Cardiac catheterization during index stay (%) | 58.9 | 43.5 | 66.9 | 74.9 | <0.0001* | 55.9 | 58.3 | 59.0 | 59.4 | 62.2 | <0.0001* |
| Statin Rx in 180d before index AMI (%) | 47.0 | 25.9 | 60.4 | 58.5 | <0.0001* | 49.5 | 47.5 | 47.3 | 46.2 | 44.7 | <0.0001* |
| Prior conditions related to statin adverse effects | |||||||||||
| Pre-Index AMI** (%) | 22.7 | 26.3 | 20.7 | 19.3 | <0.0001* | 23.9 | 22.8 | 22.3 | 21.9 | 22.5 | <0.0001* |
| During index AMI** (%) | 19.9 | 23.4 | 18.0 | 17.0 | <0.0001* | 21.2 | 20.5 | 20.0 | 19.5 | 18.6 | <0.0001* |
| ZIP code characteristics | |||||||||||
| Low income†† (%) | 49.8 | 51.3 | 49.4 | 46.5 | <0.0001* | 43.3 | 47.7 | 47.8 | 51.9 | 58.3 | <0.0001* |
| Metropolitan area (%) | 69.3 | 68.8 | 69.0 | 72.5 | <0.0001* | 76.6 | 69.3 | 69.4 | 63.5 | 67.7 | |
| Life expectancy below median (%) | 50.0 | 51.9 | 48.9 | 48.7 | 48.2 | 48.7 | 50.5 | 52.8 | 49.7 | ||
| Additional treatments after discharge | |||||||||||
| Beta blockers (%) | 66.7 | 47.9 | 77.4 | 81.2 | <0.0001* | 67.9 | 66.7 | 66.3 | 66.5 | 65.8 | <0.0001* |
| Renin-angiotensin system antagonists (%) | 48.4 | 33.2 | 56.8 | 61.7 | <0.0001* | 49.5 | 48.2 | 48.5 | 47.7 | 48.0 | <0.0001* |
| 1-Year outcomes | |||||||||||
| Survival (%) | 84.5 | 77.7 | 88.3 | 90.7 | <0.0001* | 84.5 | 84.6 | 84.6 | 84.3 | 84.7 | 0.8977 |
| Cardiovascular event-free survival (%) | 75.9 | 69.3 | 79.8 | 80.5 | <0.0001* | 75.7 | 76.1 | 75.6 | 76.0 | 75.9 | 0.6744 |
| Average Medicare costs | $10,802 | $11,119 | $10,550 | $10,842 | $10,682 | $10,738 | $10,744 | $10,989 | $10,856 | ||
| Acute renal event (%) | 15.6 | 18.5 | 13.9 | 13.7 | <0.0001* | 16.9 | 16.0 | 15.7 | 14.9 | 14.7 | <0.0001* |
| Acute hepatic event (%) | 3.8 | 3.9 | 3.6 | 4.1 | 0.0440* | 4.8 | 3.7 | 3.7 | 3.4 | 3.4 | <0.0001* |
| Muscle-related event (%) | 17.6 | 18.5 | 17.0 | 17.1 | <0.0001* | 18.2 | 17.8 | 17.5 | 17.0 | 17.3 | 0.0004* |
Cochran-Armitage 2-sided test of trend in characteristic value across patients grouped into quintiles based on local area high-intensity practice style measure. For example, the P-value for age 76–85 tests whether a linear trend in the percentage of patients in this age group exists across quintiles of the high-intensity ATR-based patient groups.
On the basis of area treatment ratio (ATR) of actual “no statin” treatment rate over predicted “no-statin” treatment rate for the 150 AMI patients living closest to a patient residence ZIP code.
On the basis of highest statin intensity available to patients in 30 days after AMI discharge.
Klabunde et al.36
ICD-9 codes 410.0 410.1
ICD-9 410.7x
See Appendix for CKD, HF, and diabetes ICD-9 codes acute renal failure/acute tubular necrosis ICD-9 584.xx; acute glomerulonephritis ICD-9 580.xx. Myopathy: ICD-9-CM 728.89, 729.1, 359.4,359.8, 359.9, 710.4, 728.9, 729.8X, E942.2; CPT codes 82550, 82552, 82554, 80012, 80016, 80018, or 80019. Acute/subacute necrosis of liver ICD-9 570.xx; hepatitis ICD-9 573.3x; other disorders of liver ICD-9 573.8x, 573.9x.
Percentage of low-income residents was above median in 2000 for beneficiary ZIP code.
P<0.05.