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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
- Source :
- BMC Cardiovascular Disorders, BMC Cardiovascular Disorders, Vol 19, Iss 1, Pp 1-13 (2019)
- Publication Year :
- 2018
-
Abstract
- 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.
- Subjects :
- Male
medicine.medical_specialty
lcsh:Diseases of the circulatory (Cardiovascular) system
Statin
Time Factors
Databases, Factual
medicine.drug_class
Hypercholesterolemia
Taiwan
Disease
030204 cardiovascular system & hematology
Drug Prescriptions
Medication Adherence
Persistence
03 medical and health sciences
Liver disease
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Secondary Prevention
Humans
030212 general & internal medicine
Medical prescription
Generalized estimating equation
Depression (differential diagnoses)
Aged
Dyslipidemias
Retrospective Studies
business.industry
Proportional hazards model
Incidence
Statins
Middle Aged
medicine.disease
Atherosclerosis
Lipids
Patient Discharge
lcsh:RC666-701
Adherence
Cohort
Female
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Cardiology and Cardiovascular Medicine
business
Biomarkers
Research Article
Subjects
Details
- ISSN :
- 14712261
- Volume :
- 19
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- BMC cardiovascular disorders
- Accession number :
- edsair.doi.dedup.....8ae0f04df60d6d198fd84fbca35e5ef5