Liao Yi-Wen Becky, Lee Mildred, Poppe Katrina K, Kerr Andrew J, Stewart Ralph A H
Department of Cardiology, Middlemore Hospital, Auckland, New Zealand; Auckland City Hospital Greenlane Cardiovascular Services, Auckland, New Zealand.
Department of Cardiology, Middlemore Hospital, Auckland, New Zealand.
Heart Lung Circ. 2023 May;32(5):612-618. doi: 10.1016/j.hlc.2023.01.015. Epub 2023 Mar 16.
Patients at risk of statin non-adherence are often not identified during hospital admission with an acute coronary syndrome (ACS).
In 19,942 patients hospitalised for ACS, statin dispensing was determined from the national pharmaceutical dispensing database. A risk score for non-adherence was developed from a multivariable Poisson regression model of associations between risk factors and the statin Medication Possession Ratio (MPR) <0.8 6-18 months after hospital discharge.
Statin MPR was <0.8 in 4,736 (24%) patients. MPR <0.8 was more likely in patients with a history of cardiovascular disease (CVD) (RR 3.79, CI 95% 3.42-4.20) and those without known CVD (RR 2.25, 95% CI 2.04-2.48) who were not taking a statin on ACS admission, compared to patients with low density lipoprotein (LDL) cholesterol <2 mmol/L who were on a statin. For patients taking a statin on admission, higher LDL was associated with MPR <0.8 (≥3 versus <2 mmol/L, RR 1.96, 95%CI 1.72-2.24). Other independent risk factors for MPR <0.8 were age <45 years, female, disadvantaged ethnic groups, and no coronary revascularisation during the ACS admission. The risk score, which included nine variables, had a C-statistic of 0.67. MPR was <0.8 in 12% of 5,348 patients with a score ≤5 (lowest quartile) and 45% of 5,858 patients with a score ≥11 (highest quartile).
A risk score generated from routinely collected data predicts statin non-adherence in patients hospitalised with ACS. This may be used to target inpatient and outpatient interventions to improve medication adherence.
在因急性冠状动脉综合征（ACS）住院期间，往往无法识别出有他汀类药物治疗依从性风险的患者。
在19942例因ACS住院的患者中，他汀类药物的配药情况由国家药品配药数据库确定。根据出院后6至18个月风险因素与他汀类药物用药持有率（MPR）<0.8之间关联的多变量泊松回归模型，制定了一个不依从风险评分。
4736例（24%）患者的他汀类药物MPR<0.8。与入院时低密度脂蛋白（LDL）胆固醇<2 mmol/L且正在服用他汀类药物的患者相比，有心血管疾病（CVD）病史的患者（相对风险3.79，95%置信区间3.42 - 4.20）以及入院时未服用他汀类药物的无已知CVD患者（相对风险2.25，95%置信区间2.04 - 2.48）的MPR<0.8的可能性更高。对于入院时正在服用他汀类药物的患者，较高的LDL与MPR<0.8相关（≥3 mmol/L与<2 mmol/L相比，相对风险1.96，95%置信区间1.72 - 2.24）。MPR<0.8的其他独立风险因素包括年龄<45岁、女性、弱势群体以及在ACS住院期间未进行冠状动脉血运重建。该风险评分包含9个变量，C统计量为0.67。在5348例评分≤5（最低四分位数）的患者中，12%的患者MPR<0.8；在5858例评分≥11（最高四分位数）的患者中，45%的患者MPR<0.8。
从常规收集的数据生成的风险评分可预测因ACS住院患者的他汀类药物治疗不依从情况。这可用于针对住院和门诊干预措施，以提高药物依从性。
