PCV73 - Adherence and Persistence with Antiplatelet Agents in Patients with New Episode of Acute Coronary Syndrome in Tianjin, China

Abstract

To investigate the adherence and persistence with antiplatelet agents and their associated factors among patients with new episode of acute coronary syndrome (ACS) in Tianjin, China. Data were obtained from Tianjin Urban Employee Basic Medical Insurance database (2011-2015). Adult patients who initiated antiplatelet agents within 30 days after discharge with a hospitalization for ACS (index hospitalization) during 2012.01.01-2014.12.31, and had continuous enrollment during 12-month pre- (baseline) and 12-month post- (follow-up) index hospitalization were included. Patients who had previous evidence of ACS or prescription of antiplatelet agents during baseline period or had major adverse cardiovascular events within the initial 30 days after discharge were excluded. Patients who had a ≥80% proportion of days covered (PDC) were considered adherent, while patients who had no gaps of ≥30 days in antiplatelet therapy were considered persistent. Logistic and Cox models were used to explore the associated factors for adherence and persistence, respectively. 5,486 patients (63.2±10.8 years; 60.2% male) were identified. Only 10.9% (N=600) of them were adherent to antiplatelet agents during follow-up, and the mean PDC was 0.39±0.29 for the total cohort. 90.1% (N=4,942) patients discontinued antiplatelet agents during follow-up and the average time to discontinuation was 103.89±110.27 days. Male, patients who received percutaneous coronary intervention (PCI) or those who had longer stay during index hospitalization had better adherence (Odds ratio [95% CI]=1.88 [1.49-2.37]; OR=3.77 [3.11-4.57]; OR=1.03 [1.01-1.05]) and persistence (Hazard Ratio [95% CI]=0.82 [0.77-0.88]; HR=0.41 [0.39-0.44]; HR=0.99 [0.98-1.00]). Patients with prior use of calcium channel blocker (CCB) (OR=0.73 [0.55-0.97]) had lower adherence, while those with prior use of β-blockers (HR=1.08 [1.00-1.17]) had lower persistence. Adherence and persistence with antiplatelet agents was unsatisfactory among patients with new episode of ACS in Tianjin, China. Male, receiving PCI and longer stay during index hospitalization were associated with better adherence/persistence.