Long-term statin adherence in patients after hospital discharge for new onset of atherosclerotic cardiovascular disease: a population-based study of real world prescriptions in Taiwan.

Autor: Chen ST; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Zhongzheng District, Taipei, Taiwan, 10055., Huang ST; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Zhongzheng District, Taipei, Taiwan, 10055., Shau WY; Pfizer Inc, No 177, Zhongzheng East Road, Tamsui District, New Taipei City, Taiwan, 25159., Lai CL; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Zhongzheng District, Taipei, Taiwan, 10055.; Department of Internal Medicine and Center for Critical Care Medicine, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Lane 442, Section 1, Jingguo Road, Hsin-Chu City, Taiwan, 30059.; Department of Internal Medicine, College of Medicine, National Taiwan University, No. 1, Section 1, Jen-ai Road, Zhongzheng District, Taipei, Taiwan, 10051., Li JZ; Pfizer Inc, 10555 Science Center Dr, San Diego, CA, 92121, USA., Fung S; Pfizer Inc, 235 E 42nd St, New York, NY, 10017, USA., Tse VC; APCER Life Sciences, Inc, 3 Independence Way, Suite 300, Princeton, NJ, 08540, USA., Lai MS; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Zhongzheng District, Taipei, Taiwan, 10055. mslai@ntu.edu.tw.
Jazyk: angličtina
Zdroj: BMC cardiovascular disorders [BMC Cardiovasc Disord] 2019 Mar 15; Vol. 19 (1), pp. 62. Date of Electronic Publication: 2019 Mar 15.
DOI: 10.1186/s12872-019-1032-4
Abstrakt: Background: Despite the recommendations of statins treatment for secondary prevention of atherosclerotic cardiovascular disease (ASCVD), treatment adherence and persistence are still a concern. This study examined the real world practice of long-term adherence and persistence to statins treatment initiated after hospital discharge for ASCVD, and their associated factors in a nationwide cohort.
Methods: Post discharge statin prescriptions between 2006 and 2012 were extracted from the Taiwan National Health Insurance claims database. Good adherence, defined as proportion of days covered (PDC) ≥0.8 and mean medication possession ratio (MPR), was measured every 180-day period. Non-persistence was defined on the date patients failed to refill statin for 90 days after the end of the last prescription. Their associations with influential factors were analyzed using a generalized estimating equation and Cox's proportional hazard model.
Results: There was a total of 185,252 post-discharge statin initiations (from 169,624 patients) and followed for 467,398 patient-years in the study cohort. Percentage of good adherence (mean MPR) was 71% (0.87) at 6-months; declined to 54% (0.68), 47% (0.59), and 42% (0.50) at end of year 1, 2, and 7, respectively. Persistence in statin treatment was 86, 67, 50, and 25% at 6-month, 1-, 2-, and 7-year, respectively. Comparing the statin-cohort initiated from year 2006 to 2012, 1-year persistence increased from 58 to 73%, and 1-year good adherence improved from 45 to 61%. Factors associated with sub-optimal adherence and non-persistence included: prescription by primary care clinics or non-cardiology specialties; patients' age > 75 years; no history of previous statin use; ASCVD events with ischemic stroke diagnosis; comorbidities of renal disease, liver disease, depression, and chronic obstructive pulmonary disease.
Conclusions: Despite the improving trends, long-term adherence and persistence of statin treatment were suboptimal in Taiwan. Strategies to maintain statin treatment adherence and persistence need to be implemented to further enhance the positive trend.
Databáze: MEDLINE
Externí odkaz: