Use of the statins in patients after acute myocardial infarction - Does evidence change practice?

Objective: To compare the use of lipid-lowering agents in 42628 elderly pat ients (aged greater than or equal to 65 years) alter acute myocardial infar ction, before and after the publication of the Scandinavian Simvastatin Sur vival Study (45), using the Ontario Myocardial Infarction Database. Methods: Multivariate regression models were created to estimate changes in the rate of statin use over time in monthly cohorts of elderly patients af ter acute myocardial infarction in Ontario from April 1, 1992, to March 31, 1997. Changes in the rate of statin use over time were estimated using pat ient and prescriber characteristics. Results: We found a 3.6-fold significant increase in the monthly rate of st atin use after the publication of 45 compared with before the publication o f 4S (P<.001); specifically, the rate of increase in simvastatin and pravas tatin sodium use was higher after the publication of 4S (P<.001 for each). Before the publication of 45, the rate of increase in statin use in younger patients (aged 65-74 years) was 2.7 times higher than in older patients (a ged greater than or equal to 75 years) (P = .02), while after the publicati on of 4S, the rate of increase in statin use was only 1.8-fold higher in th e younger group (P<.001). After the publication of SS, there was a 1.6-fold higher rate of increase in statin use in male compared with female patient s (P = .006). Also after the publication of 4S, specialists (cardiologists and internists) had a 2-fold higher rate of increased use of the statins th an did generalists (P<.001). Conclusion: It is possible to shift practice if the evidence of benefit is strong, the intervention is easy to implement, and the intervention is mark eted aggressively.