July 26, 2019 / 8:56 PM / 23 days ago

In the U.S., getting the right medicine after a heart attack may depend on where you live

(Reuters Health) - Where heart attack survivors live in the U.S. may affect their chances of getting the best medication to prevent a second attack, a new study suggests.

Researchers found that New Englanders were most likely to get the right therapy after a heart attack, while those in the central part of the country were least likely.

Women overall were less likely than men to receive the appropriate medication after a heart attack, according to the report in JAMA Cardiology.

“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,” said the study’s lead author, Dr. Vera Bittner, section head of general cardiology, prevention and imaging at the University of Alabama, Birmingham.

High-intensity and moderate-intensity statin therapy are defined by how much they reduce levels of LDL-cholesterol in the blood, she explained. On average, high-intensity statins achieve about a 50% reduction and moderate-intensity statins achieve about a 30% reduction.

To take a closer look at whether geography plays a role in the prescribing of high-intensity statins to heart attack survivors, Bittner and her colleagues studied Medicare data on nearly 140,000 patients aged 66 and older who were hospitalized for a heart attack in 2014 or 2015.

When they analyzed the data by geographic region, they found that patients from New England were the most likely to receive a high-intensity statin (73%), while those from the West South Central U.S., which included states such as Arkansas, Oklahoma and Louisiana, were the least likely (41%).

Patients in larger hospitals (with 500 or more beds) were also more likely than those in the smallest hospitals (with fewer than 100 beds) to get high-intensity statins: 59% versus 39%. Women were less likely than men to get high-intensity statins: 49% versus 56%.

Bittner and her colleagues don’t know why patients from certain areas of the country are less likely to receive high-intensity statins after a heart attack.

“The regional differences are evident even when we adjusted for patient and hospital characteristics,” she said in an email. “It is also unlikely to be lack of access to information on the healthcare providers’ part - guidelines are easily accessible on the internet, so are conference proceedings, papers, etc. It is also not access to prescriptions because our population only included individuals with Medicare Part D prescription coverage.”

Bittner hopes the new findings will spur hospitals all around the country to scrutinize their own data.

“If they find underutilization,” she said, “then they should develop treatment pathways designed to improve the treatment gap: 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? Yes/No, if no provide reason,’ may help.”

The new findings make sense in light of earlier research showing that the same areas of the country with lower prescription rates for high-intensity statins are also the ones with the highest heart disease death rates, said Dr. Suzanne Steinbaum, director of Women’s Cardiovascular Prevention, Health and Wellness at The Mount Sinai Hospital in New York City.

If physicians are part of the problem, “then we really need to take a look at this study and make sure we are part of the solution,” Steinbaum said. While the researchers found an overall increase in the use of high-intensity statins, from 23% in 2011 to 56% in 2015, “an almost two-fold improvement, quite frankly, is not impressive,” she added.

Steinbaum was also concerned that women still aren’t getting the same treatment after a heart attack as men. “Sadly, it’s not surprising,” she said. “But it’s never not upsetting. The guidelines are very clear. We need to be treating everyone equally.”

SOURCE: bit.ly/314gJWZ JAMA Cardiology, online July 24, 2019.

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