Statin adherence after acute coronary events
█ Original article
Simon Attila1, Kósa István2, Vassányi István3, Andrássy Gábor4, Erdei Ferenc5, Kohut László2, Páder Katalin6, Simon Éva7, Szász Károly8, Veress Gábor1, Tiringer István9
1Balatonfüredi Állami Szívkórház, Balatonfüred,
2Magyar Honvédség Egészségügyi Központ – Honvédkórház, Balatonfüredi Kardiológiai Rehabilitációs Intézet, Balatonfüred,
3Pannon Egyetem, Műszaki Informatikai Kar, Egészségügyi Informatikai Kutató-Fejlesztő Központ (EIKFK), Veszprém,
4Budapesti Szent FerencKórház, Budapest,
5Békés Megyei Központi Kórház, Pándy Kálmán Tagkórház, Gyula
6Bajcsy-Zsilinszky Kórház és Rendelőintézet, Budapest,
7Soproni Erzsébet Oktató Kórház és Rehabilitációs Intézet, Sopron,
8Csongrád Megyei Önkormányzat Mellkasi Betegségek Szakkórháza, Deszk
9PTE ÁOK, Magatartástudományi Intézet, Pécs
Effective lowering of cholesterol level is the basic element of secondary prevention after acute coronary events. This can be achieved mainly with high dose HMG-CoA reductase inhibitors (statins). Although statins can markedly decrease the risk of repeated vascular events, the patients’ poor adherence to this kind of lipid lowering therapy is well known. This can be a reason of high percentage of patients, who do not reach the lipid target values, and can lead to increased cardiovascular morbidity and mortality among patients with former vascular events.
Aims: Our aims were to describe statin adherence (using both self-report and medical dispensation data) among different groups of patients, who participated in cardiac rehabilitation after coronary events.
Patients and methods: In or prospective, multicenter trial we evaluated the statin therapy and 1 year adherence of 445 patients (age: 61.3±8.7 year, 70.1% men) where both self-reported statin use and medical dispensation data were available. Patients were included in the trial after acute myocardial infarction (AMI group, 289 patients), after percutaneous coronary intervention (PCI group, 53 patients) or after coronary artery bypass graft operation (ACBG group, 103 patients). 12 months after the discharge from rehabilitation patients were asked about their medication in questionnaires, or in standardized telephone interview. Medical dispensation data, that were available from the medical insurance database allowed us to compute medical adherence and persistence.
Results: Even at the baseline evaluation significantly less patients took statin in the ACBG group (Total population: 95.1%, AMI: 96.9%, PCI: 96.2%, ACBG: 89.3%, p<0.01). At the same time the LDL cholesterol level was the highest in this group (Total population: 1.98±0.79, AMI: 1.97±0.81, PCI: 1.74±0.68 ACBG: 2.12±0.75 mmol/l, p<0.01). 12 months later 83.6% of the total patient population took statins according to self-report, there were no differences between groups (AMI: 85.0%, PCI: 84.3%, ACBG: 79.4%). Medical dispensation data described a much worse situation the proportion of patients who took at least 80% of prescribed medication was 53.8% in the total population (57.1% in AMI, 51.9% in PCI, and 44.8% in the ACBG groups, no significant differences). Using a multivariable logistic regression model from the baseline variables neither was significant predictors of the variance of statin adherence. The persistence of the patients was the highest in the AMI group.
Conclusion: Although high percent of patients had statin treatment, the ACBG group had lower rate of treatment even at the baseline. 12 months later the proportion of patients who are adherent to the statins is particularly low.