Postdischarge Proton Pump Inhibitor and Clopidogrel Use Among Medicare ACS Patients with Percutaneous Coronary Intervention

Objectives: A retrospective study examined post-discharge proton pump inhibitor (PPI) use with clopidogrel for Medicare patients hospitalized for ACS and treated with percutaneous coronary intervention (PCI). Methods: Claims from a large national US health plan were analyzed. Subjects were enrolled in Medicare Advantage with Part D prescription drug coverage (MAPD), >65 years old, had at least one inpatient hospitalization with a primary ACS diagnosis code between 1/1/2007 and 12/31/2008, and were treated with percutaneous coronary intervention (PCI). Excluded were patients with baseline stroke or TIA. Patients were followed up until death or 365 days post-discharge, whichever came first. Results: Of 1350 patients that met the inclusion criteria, 53.5% (722 of 1350) were ≥75 years old, 36.6% (494 of 1350) had diabetes comorbidity, and 6.9% (93 of 1350) had a prior myocardial infarction (MI). Of patients ≥ 75 years old, 37.8% (273 of 722) had either diabetes comorbidity or a prior MI. In the post-discharge period, 88.3% (1192 of 1350) had at least one clopidogrel fill and 33.1% (447 of 1350) had at least one PPI fill. Mean number of PPI claims was 6.1 (±4.3); mean number of clopidogrel fills was 8.3 (±4.1). Of patients with any PPI use, 87.9 % (393 of 447) were also on clopidogrel for an overlapping period of time. Average overlapping period was 161.1 (±114.7) days. The most common PPI fill was 47.7% (213 of 447) for omeprazol, followed by 31.1% (139 of 447) for pantoprazole, 21.0% (94 of 447) for esomeprazole, and 10.7% (48 of 447) for all others. Conclusion: Concomitant use of clopidogrel and PPI following hospital discharge for ACS-PCI was frequently observed in this managed Medicare population.