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

BackgroundEvidence 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.MethodsWe constructed...

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Bibliographic Details
Published in:Heart Asia 2019-08, Vol.11 (2), p.e011176
Main Authors: Shau, Wen-Yi, Lai, Chao-Lun, Huang, Shih-Ting, Chen, Shu-Ting, Li, Jim Z, Fung, Selwyn, Tse, Vicki C, Lai, Mei-Shu
Format: Article
Language:English
Subjects:
Atherosclerosis
Cardiovascular disease
Health insurance
Mortality
Original Research
Statins
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Summary:BackgroundEvidence 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.MethodsWe 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.ResultsThe 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
ISSN:1759-1104
1759-1104
DOI:10.1136/heartasia-2018-011176