Cardiology Advanced Trainee, Counties Manukau District Health Board, New Zealand.
Biostatistician, Counties Manukau District Health Board, New Zealand.
N Z Med J. 2021 Apr 30;134(1534):31-45.
Prior New Zealand studies suggest that only approximately two-thirds of patients who present with an acute coronary syndrome (ACS) are adequately maintained on a statin post-discharge. This could be due to low initiation and/or poor longer-term adherence.
To identify the pattern and adequacy of statin maintenance following ACS from initial prescription to one-year post-discharge.
All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry data for consecutive New Zealand residents (2015-2017) who were hospitalised with ACS and managed with coronary angiography were anonymously linked to national datasets to derive a medication possession ratio (MPR) to assess medication maintenance. An MPR ≥0.8 is considered adequate maintenance and ≥1 is considered optimal.
Of the 16,557 patients who survived their ACS, 15,431 (93.2%) were prescribed a statin at discharge and 89.8% were dispensed a statin within three months. 79.8% (13,219/16,557) of patients had an MPR ≥0.8 during the first year, but only 61.0% (10,096/16,557) had optimal dispensing over this period. Regression analysis identified the independent predictors of sub-optimal maintenance over the first year as age <45 years, no prior statin and Māori and Pacific ethnicity.
After ACS discharge, the gap between prescribing and dispensing rates was small with only minor demographic variation. One in ten patients were not initially dispensed a statin. Although eight in ten patients were adequately maintained, only six in ten had optimal maintenance with clear ethnic and age differences, which may reflect more general disparities in healthcare.
新西兰此前的研究表明，在出院后，仅有大约三分之二的急性冠状动脉综合征（ACS）患者能够持续接受他汀类药物治疗。这可能是由于起始治疗率低和/或长期依从性差。
确定 ACS 患者从初始处方到出院后一年期间他汀类药物维持治疗的模式和充分性。
对 2015 年至 2017 年期间新西兰连续住院的 ACS 患者（ANZACS-QI 注册研究数据）进行匿名链接，以获取国家数据集，计算药物使用比例（MPR）以评估药物维持情况。MPR≥0.8 被认为是充分维持，MPR≥1 被认为是最佳维持。
在幸存的 ACS 患者中，有 16557 名患者出院时被开具了他汀类药物处方，其中 15431 名（93.2%）在三个月内开具了他汀类药物。在第一年中，有 79.8%（13219/16557）的患者 MPR≥0.8，但在这段时间内仅有 61.0%（10096/16557）的患者最佳给药。回归分析确定了第一年中他汀类药物维持不理想的独立预测因素为年龄<45 岁、无既往他汀类药物治疗史以及毛利族和太平洋族裔。
ACS 出院后，开具处方和发放药物之间的差距较小，只有细微的人口统计学差异。有十分之一的患者最初没有被发放他汀类药物。尽管有十分之八的患者得到了充分的维持治疗，但只有十分之六的患者得到了最佳的维持治疗，存在明显的种族和年龄差异，这可能反映了更普遍的医疗保健差距。
