College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Can J Cardiol. 2012 Sep-Oct;28(5):567-73. doi: 10.1016/j.cjca.2012.03.018. Epub 2012 May 31.
Adherence to statin medications is known to be suboptimal. What is less known is the rate of discontinuation immediately after therapy has been initiated. The primary objective of this study was to determine what proportion of nonadherence in the first year of statin therapy was due to discontinuation after a single fill.
We identified new statin users within low-risk (hypertension [HTN]), medium-risk (coronary heart disease [CHD]), and high-risk (heart failure [HF]) cohorts during a 9-year period. All data came from administrative health care databases.
The cohorts included 9445 HTN, 1141 CHD, and 778 HF patients. At 1 year, the proportions of patients with less than 80% adherence to statin medications were 47.9% (HTN), 38.3% (CHD), and 50.0% (HF). Among all patients classified as nonadherent at 1 year, 18.0% of HTN, 16.3% of CHD, and 28.2% of HF patients had discontinued statin medications after only 1 dispensation. Within 3 months of starting statin therapy, 29.7%, 40.3%, and 47.5% of all nonadherent HTN, CHD, and HF patients, respectively, had discontinued the new statin medication. After regression analysis, the only independent covariate that was consistently associated with discontinuation after a single fill was receiving fewer medical follow-up visits.
Immediate discontinuation after a single fill contributes disproportionately to statin nonadherence. This suggests an important time to prevent nonadherence is within the first month of treatment initiation.
他汀类药物的依从性不尽人意，而在开始治疗后立即停药的比例则知之甚少。本研究的主要目的是确定他汀类药物治疗的第一年中，因单次用药后停药导致的不依从比例。
在 9 年期间，我们在低危（高血压[HTN]）、中危（冠心病[CHD]）和高危（心力衰竭[HF]）队列中确定了新的他汀类药物使用者。所有数据均来自行政医疗保健数据库。
队列包括 9445 例 HTN、1141 例 CHD 和 778 例 HF 患者。在 1 年时，他汀类药物用药依从性不足 80%的患者比例分别为 47.9%（HTN）、38.3%（CHD）和 50.0%（HF）。在所有被归类为 1 年时不依从的患者中，18.0%的 HTN、16.3%的 CHD 和 28.2%的 HF 患者在仅接受 1 次配药后就停止了他汀类药物治疗。在开始他汀类药物治疗后的 3 个月内，分别有 29.7%、40.3%和 47.5%的所有不依从 HTN、CHD 和 HF 患者停止了新的他汀类药物治疗。回归分析后，唯一与单次用药后停药相关的独立协变量是接受的医疗随访次数较少。
单次用药后立即停药是导致他汀类药物不依从的主要原因。这表明在治疗开始后的第一个月内，预防不依从的重要时间点。
