A simplified method for bundling fixed doses of a generic statin and angiotensen-converting enzyme inhibitor/angiotensin receptor blocker (ACE-I/ARB) was successfully implemented in a large, diverse population in an integrated health care delivery system, reducing the risk of hospitalization and stroke, according to a observation study published Oct. 1 online in the American Journal of Managed Care.
In 2003, Kaiser Permanente developed the ALL initiative (Aspirin, Lisinopril and Lipid-Lowering Medication) to reduce heart attacks and strokes by aggressively enrolling patients with heart disease, or patients over 55 with diabetes, in a therapeutic program that included the use of a triad of medications: low-dose aspirin, lovastatin (Mevacor) and lisinopril (Zestril, Prinivil).
Researchers studied 170,024 ethnically diverse members who were diagnosed with coronary artery disease (CAD) or over the age of 55 and diagnosed with diabetes, not already taking both bundle medications as of 2003, and continuously enrolled between Jan. 1, 2001 and Dec. 31, 2006.
R. James Dudl, MD, the diabetes clinical lead at Kaiser Permanente's Care Management Institute, and colleagues broke the study cohort into three groups: 21,292 members in the high-exposure group who took the bundled drugs more than half of the time in 2004 and 2005 based on their prescription refill habits; a low-exposure group of 47,268 people who took the drug bundle less than half of the time during 2004 and 2005 based on their prescription refill habits, and a no-exposure group of 101,464 people who either took neither or just one type of the tracked drugs during 2004 and 2005.
The authors found that among the study population as a whole, there were 21 heart attacks and strokes per 1,000 people in 2006. Among the 47,268 people in the group that had low exposure to the drugs, there were 726 fewer heart attacks and strokes than in the no-exposure group, equivalent to a reduction of 15 heart attacks and strokes per 1,000 people. Among the 21,292 people in the high- exposure group, there were 545 fewer heart attacks and strokes, equivalent to a reduction of 26 heart attacks and strokes per 1,000 people.
Based on these results, Dudl and colleagues estimated this effect to be a 60 percent savings of these events.
The researchers acknowledged that they lack data on population characteristics needed to “precisely estimate the impact of widely implementing the all bundle across the U.S. healthcare delivery system.” However, they assumed that if 20 percent of the 5.8 million Americans over the age of 65 who are predicted to have diabetes by the year 2010 were exposed to the bundle for one to 365 days over 24 months, more than 17,000 MIs and strokes would be avoided the following year.
The authors concluded that preventing adverse cardiovascular events among populations at risk is a pressing, ongoing need and developing next-generation statins and ACE inhibitors consumes substantial resources.