Secondary prevention of coronary artery disease: a retrospective observational analysis of italian healthcare administrative data

Abstract

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): ACARPIA Farmaceutici S.r.l. Background/Introduction Prevalence and mortality rates in patients with a documented coronary artery disease (CAD) are high, mainly due to the suboptimal adherence to the recommendations of current guidelines on secondary prevention strategies. Purpose This study aimed to describe patients with CAD and eligible to secondary prevention and assess their 1-year healthcare resource consumption and costs, from the perspective of the Italian National Health Service (INHS). Methods From our database of Italian healthcare administrative data, reliably representative of the whole Italian population, a cross-linkage of demographics, hospital discharges and exemption code for disease cost sharing, through a unique anonymized identifying code, was performed. Patients aged ≥35 in 2018 (accrual period) with CAD (index date) and eligible to secondary prevention (by excluding subjects with end-stage kidney disease/neoplasia) were selected. They were characterized in terms of age, gender and comorbidities (from index date back to 2015) and followed for 1 year to assess drug consumption, hospitalizations and healthcare integrated costs. Results Out of >5 million inhabitants in the database in 2018, 46,063 patients aged ≥35 (1.3%) with CAD and eligible for secondary prevention were selected (72.1% males; mean age [±SD] 70±12). About half of them had 3 or more comorbidities of interest: mostly hypertension (90%), dyslipidaemia (72%) and diabetes (33%). During 1-year follow-up, at least one drug for secondary prevention was supplied to 96.4% of patients: mainly antiplatelets (83%), lipid lowering agents (83%) and β-blockers (73%). At the same time, 95.8% of the cohort was treated with at least one non-cardiovascular drug. The 30.6% of subjects were hospitalized at least once: 11.4% due to relevant cardiovascular causes (mostly acute coronary syndrome and heart failure), 9.1% due to other cardiovascular events and 17.5% because of non-cardiovascular events. On average, the INHS yearly paid €6,078 per patient: hospitalizations accounted for the 70% of the whole expenditure. Conclusions This study showed an integrated view of the relevant burden of CAD for patients and the INHS. A multidisciplinary and a more adherent approach to current guidelines are compelling to improve patients’ outcomes and reduce costs for the INHS.