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In-Hospital Initiation of Lipid-Lowering Therapy After Coronary Intervention as a Predictor of Long-term Utilization
A Propensity Analysis
Herbert D. Aronow, MD, MPH;
Gian M. Novaro, MD;
Michael S. Lauer, MD;
Danielle M. Brennan, MS;
A. Michael Lincoff, MD;
Eric J. Topol, MD;
Dean J. Kereiakes, MD;
Steven E. Nissen, MD
Arch Intern Med. 2003;163:2576-2582.
Background Despite multiple randomized trials demonstrating their efficacy for the secondary prevention of coronary disease, lipid-lowering agents remain underused. Few studies have examined the relationship between predischarge initiation of lipid-lowering therapy and long-term use.
Methods Using data from patients at 69 centers from the United States and Canada enrolled in the Evaluation in PTCA to Improve Long-term Outcome With Abciximab GP IIb/IIIa Blockade (EPILOG) trial, we performed a retrospective propensity-analyzed cohort study. Patients underwent percutaneous coronary intervention for stable or recently unstable coronary disease and were older than 21 years, were not taking lipid-lowering therapy at the time of admission, and survived to hospital discharge; 175 were discharged taking lipid-lowering therapy and 1951 were not.
Results After 6 months, 77% of patients who started taking lipid-lowering agents before hospital discharge continued taking therapy, compared with only 25% of those discharged without these agents (relative risk, 3.17; 95% confidence interval, 2.88-3.41; P<.001). After restricting the analysis to propensity-matched patients (n = 477) and adjusting for other potential confounders, initiation of a lipid-lowering agent during hospitalization was the strongest independent predictor of use at 6 months (relative risk, 2.50; 95% confidence interval, 2.29-2.65; P<.001).
Conclusions Inpatient initiation of lipid-lowering therapy is a strong and independent positive predictor of subsequent use, with patients who start taking lipid-lowering therapy before hospital discharge nearly 3 times as likely to be taking these agents 6 months later. Inpatient initiation of lipid-lowering therapy appears to be an effective strategy for bridging the gap between current medical knowledge and practice.
From the Division of Cardiovascular Medicine, Department of Internal Medicine, University of Pennsylvania Medical Center and Philadelphia Veterans Administration Medical Center, Philadelphia (Dr Aronow); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio (Drs Novaro, Lauer, Lincoff, Topol, and Nissen and Ms Brennan); and Carl and Edyth Lindner Research Center for Clinical Cardiovascular Research, Cincinnati, Ohio (Dr Kereiakes). The authors have no relevant financial interest in this article.
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