Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
MRC Population Health Research Unit, Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Heart. 2023 Feb 14;109(5):388-395. doi: 10.1136/heartjnl-2022-321452.
To estimate the extent of suboptimal statin use for the secondary prevention of atherosclerotic cardiovascular disease (ASCVD) at different stages of the treatment pathway and identify patient groups at risk of suboptimal treatment.
National retrospective cohort study using linked National Health Service Scotland administrative data of adults hospitalised for an ASCVD event (n=167 978) from 2009 to 2017. Proportions of patients initiating, adhering to, discontinuing and reinitiating statins were calculated. We separately examined treatment following myocardial infarction (MI), ischaemic stroke and peripheral arterial disease (PAD) hospitalisations. Multivariable logistic regression and Cox proportional hazards models were used to assess the roles of patient characteristics in the likelihood of initiating and discontinuing statins.
Of patients hospitalised with ASCVD, only 81% initiated statin therapy, 40% of whom used high-intensity statin. Characteristics associated with lower odds of initiation included female sex (28% less likely than men), age below 50 years or above 70 years (<50 year-olds 26% less likely, and 70-79, 80-89 and ≥90 year-olds 22%, 49% and 77% less likely, respectively, than 60-69 year-olds), living in the most deprived areas and history of mental health-related hospital admission. Following MI, 88% of patients initiated therapy compared with 81% following ischaemic stroke and 75% following PAD events. Of statin-treated individuals, 24% discontinued treatment. Characteristics associated with discontinuation were similar to those related to non-initiation.
Statin use remains suboptimal for the secondary ASCVD prevention, particularly in women and older patients, and following ischaemic stroke and PAD hospitalisations. Improving this would offer substantial benefits to population health at low cost.
评估在治疗路径的不同阶段，用于二级预防动脉粥样硬化性心血管疾病（ASCVD）的他汀类药物的不充分使用程度，并确定有不充分治疗风险的患者群体。
这是一项使用苏格兰国民保健系统（NHS Scotland）行政数据进行的全国回顾性队列研究，纳入了 2009 年至 2017 年期间因 ASCVD 事件住院的成年人（n=167978）。计算了起始、坚持、停药和重新起始他汀类药物的患者比例。我们分别检查了心肌梗死（MI）、缺血性卒中和外周动脉疾病（PAD）住院后的治疗情况。使用多变量逻辑回归和 Cox 比例风险模型评估了患者特征在起始和停药他汀类药物的可能性中的作用。
在 ASCVD 住院患者中，只有 81%起始了他汀类药物治疗，其中 40%使用了高强度他汀类药物。起始他汀类药物治疗可能性较低的特征包括女性（比男性低 28%）、年龄低于 50 岁或高于 70 岁（<50 岁的可能性低 26%，70-79 岁、80-89 岁和≥90 岁的可能性分别低 22%、49%和 77%，与 60-69 岁相比）、居住在最贫困地区和有心理健康相关住院史。MI 后，88%的患者起始了治疗，而缺血性卒中和 PAD 事件后，起始治疗的患者比例分别为 81%和 75%。在接受他汀类药物治疗的患者中，有 24%停药。与未起始治疗相关的特征相似，与停药相关的特征也是如此。
他汀类药物在二级 ASCVD 预防中的使用仍然不充分，特别是在女性和老年患者以及缺血性卒中和 PAD 住院后。改善这一点将以低成本为人群健康带来巨大益处。
