Abstract
BackgroundDespite the recommendations of statins treatment for secondary prevention of atherosclerotic cardiovascular disease (ASCVD), treatment adherence and persistence are still a concern. This study examined the real world practice of long-term adherence and persistence to statins treatment initiated after hospital discharge for ASCVD, and their associated factors in a nationwide cohort.MethodsPost discharge statin prescriptions between 2006 and 2012 were extracted from the Taiwan National Health Insurance claims database. Good adherence, defined as proportion of days covered (PDC) ≥0.8 and mean medication possession ratio (MPR), was measured every 180-day period. Non-persistence was defined on the date patients failed to refill statin for 90 days after the end of the last prescription. Their associations with influential factors were analyzed using a generalized estimating equation and Cox’s proportional hazard model.ResultsThere was a total of 185,252 post-discharge statin initiations (from 169,624 patients) and followed for 467,398 patient-years in the study cohort. Percentage of good adherence (mean MPR) was 71% (0.87) at 6-months; declined to 54% (0.68), 47% (0.59), and 42% (0.50) at end of year 1, 2, and 7, respectively. Persistence in statin treatment was 86, 67, 50, and 25% at 6-month, 1-, 2-, and 7-year, respectively. Comparing the statin-cohort initiated from year 2006 to 2012, 1-year persistence increased from 58 to 73%, and 1-year good adherence improved from 45 to 61%. Factors associated with sub-optimal adherence and non-persistence included: prescription by primary care clinics or non-cardiology specialties; patients’ age > 75 years; no history of previous statin use; ASCVD events with ischemic stroke diagnosis; comorbidities of renal disease, liver disease, depression, and chronic obstructive pulmonary disease.ConclusionsDespite the improving trends, long-term adherence and persistence of statin treatment were suboptimal in Taiwan. Strategies to maintain statin treatment adherence and persistence need to be implemented to further enhance the positive trend.
Highlights
Despite the recommendations of statins treatment for secondary prevention of atherosclerotic cardiovascular disease (ASCVD), treatment adherence and persistence are still a concern
There were 185,252 post-discharge statin initiations identified from 169,624 patients in Taiwan National Health Insurance (NHI) claims database between January 2006 and December 2012
The mean age of patients at statin initiation was 65.4 years; 66% were males; 82% had received statin during hospitalization, and 47% had received statins during the year prior to the ASCVD hospitalization
Summary
Despite the recommendations of statins treatment for secondary prevention of atherosclerotic cardiovascular disease (ASCVD), treatment adherence and persistence are still a concern. This study examined the real world practice of long-term adherence and persistence to statins treatment initiated after hospital discharge for ASCVD, and their associated factors in a nationwide cohort. Non-adherence to medication is a major problem in patients with chronic conditions including cardiovascular diseases [1, 2]. 50% of patients with chronic diseases are not adherent to medications in developed countries including the United States [3]. It was estimated that medication non-adherence lead to approximately 10% of hospital admissions, caused 125,000 deaths from cardiovascular diseases per year in the United States, and results in a cost of approximately US$100 billion per year [3, 8]. Maintaining good levels of treatment adherence and persistence for chronic conditions, which requires long-term management, is essential to maintaining the treatment effect. Information regarding the level of treatment adherence and persistence as well as their potential influential factors is important to enhance effectiveness of health care delivery
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