Department of Cardiology, Health Science University, Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey.
Department of Cardiology, Health Science University, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey.
Acta Cardiol. 2021 Oct;76(8):852-858. doi: 10.1080/00015385.2020.1794162. Epub 2020 Jul 17.
In the present study, we aimed to evaluate compliance to lipid lowering guidelines regarding statin prescription on discharge and statin adherence rates during a follow-up period of one year in patients hospitalised with a diagnosis of acute coronary syndrome (ACS).
In-hospital records of 3506 ACS patients, of which 771 had experienced an ST-elevation myocardial infarction (STEMI) and 2735 had experienced a non-STEMI, were collected. We calculated medication possession ratios (MPRs) for each subject. We designated patients with ≥9 statin refills/year (MPR ≥ 0.75) as the statin-adherent group and patients with <9 statin refills/year (MPR < 0.75) as the statin-non-adherent group.
During a 12-month follow-up period, 234 patients in the STEMI group (30.3%) and 391 patients in the non-STEMI group (14.3%) had 12 refills of statin. Thus, only 17.8% of the total study population had complete adherence to statin therapy with an MPR of 1. When patients with ≥9 statin prescriptions were categorised as the statin-adherent group, only 1575 patients (44.9%) were found to be adherent to statin treatment. In multivariate analysis, patients with a non-STEMI diagnosis and high intensity statin treatment had higher rates of non-adherence (OR:1.685, 95%CI:1.412-2.012, < .01 and OR:1.344, 95% CI: 1.147-1.574, < .01, respectively). Patients with prior statin treatment had lower rates of non-adherence(OR:0.437, 95%CI: 0.346-0.553, < .01).
The present study shows that compliance with guidelines regarding statin initiation during hospitalisation and statin adherence rates during a one-year follow-up period are low for patients treated for ACS. Considering the overwhelming clinical benefits of high-intensity statins in patients with ACS, every effort should be made to increase the rate of optimal use of statins in secondary prevention.
在本研究中，我们旨在评估急性冠状动脉综合征（ACS）住院患者出院时降脂药物使用指南的他汀类药物处方遵从情况以及一年内他汀类药物依从率。
收集了 3506 例 ACS 患者的住院病历，其中 771 例发生 ST 段抬高型心肌梗死（STEMI），2735 例发生非 ST 段抬高型心肌梗死（NSTEMI）。我们计算了每位患者的药物利用率（MPR）。我们将他汀类药物每年≥9 次（MPR≥0.75）的患者定为他汀类药物依从组，每年<9 次（MPR<0.75）的患者定为他汀类药物不依从组。
在 12 个月的随访期间，STEMI 组有 234 例（30.3%）和 NSTEMI 组有 391 例（14.3%）患者服用了 12 次他汀类药物。因此，只有 17.8%的患者对他汀类药物治疗的依从性完全符合指南（MPR 为 1）。当我们将他汀类药物每年≥9 次的患者归类为他汀类药物依从组时，仅有 1575 例（44.9%）患者符合他汀类药物治疗的依从性。多变量分析显示，与 NSTEMI 诊断和高强度他汀类药物治疗相关的患者具有更高的不依从率（比值比：1.685，95%可信区间：1.412-2.012， < .01；比值比：1.344，95%可信区间：1.147-1.574， < .01）。而有他汀类药物治疗史的患者不依从率较低（比值比：0.437，95%可信区间：0.346-0.553， < .01）。
本研究表明，ACS 患者在住院期间开始使用他汀类药物的指南遵从性以及在一年的随访期间的他汀类药物依从率均较低。鉴于高强度他汀类药物在 ACS 患者中的临床获益显著，应尽一切努力提高二级预防中他汀类药物的最佳使用率。
