Statin adherence and persistence on secondary prevention of cardiovascular disease in Taiwan.

Autor:	Shau WY; Medical Affairs, Pfizer Taiwan, New Taipei, Taiwan., Lai CL; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.; Department of Internal Medicine and Center for Critical Care Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan., Huang ST; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan., Chen ST; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan., Li JZ; Global Health and Value, Pfizer, San Diego, California, USA., Fung S; APAC regional Medical Affairs, Pfizer, New York City, New York, USA., Tse VC; APCER Life Sciences, Princeton, New Jersey, USA., Lai MS; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Jazyk:	angličtina
Zdroj:	Heart Asia [Heart Asia] 2019 Sep 02; Vol. 11 (2), pp. e011176. Date of Electronic Publication: 2019 Sep 02 (Print Publication: 2019).
DOI:	10.1136/heartasia-2018-011176
Abstrakt:	Background: Evidence and treatment guidelines support the use of statins in patients with established atherosclerotic cardiovascular disease (ASCVD) for secondary prevention of subsequent cardiovascular (CV) event. However, treatment adherence and persistence are still a concern. Methods: We constructed a retrospective population-based cohort of patients, who initiated statin treatment within 90 days after discharge from hospital for ASCVD using the claims database of Taiwan National Health Insurance. Proportion of days covered (PDC) was used to measure statin adherence, and PDC ≥80% was defined as good adherence. The study outcomes were subsequent rehospitalisation or in-hospital death due to composite ASCVD, myocardial infarction or ischaemic stroke. Their associations with statin prescription adherence or persistence were analysed using time-dependent Cox proportional hazards model. Results: The study cohort included 185 252 postdischarge statin initiators. There were 50 015 subsequent ASCVD rehospitalisations including 2858 in-hospital death during 7 years of study period. Good adherence was significantly associated with lower risk of ASCVD rehospitalisation (adjusted HR (aHR) 0.90; 95% CI 0.87 to 0.92) and significantly lower risk of in-hospital death (aHR 0.59; 95% CI 0.53 to 0.65). Compared with constant use of statin, patients in the three less persistent states (recent stop, non-persistence and intermittent use) were associated with higher risk of subsequent ASCVD rehospitalisation, aHRs were 1.16, 1.13 and 1.26, respectively (all p<0.05). The increased risks were consistent with specific outcome of acute myocardial infarction and ischaemic stroke. Also, patients in the recent stop period had significantly higher risk for fatal CV event. Conclusions: Good adherence and persistence to statin therapy are significantly associated with lower risk of secondary ASCVD rehospitalisation and in-hospital death. Competing Interests: Competing interests: Among the authors of this study, WYS, JZL and SF are employees of Pfizer. STH, STC and MSL received research grant from Pfizer. VCT, who is an employee of APCER, received funding from Pfizer. CLL received consultancy fee from Pfizer. (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu