Long-term statin adherence in patients after hospital discharge for new onset of atherosclerotic cardiovascular disease: a population-based study of real world prescriptions in Taiwan

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.

Real‐world evaluation of the impact of statin intensity on adherence and persistence to therapy: A Scottish population‐based study

“…Unexpectedly, compared to moderate statin intensity, high-intensity statin therapy was associated with better adherence and persistence to treatment, and lower discontinuation rates. Nevertheless, in line with other published studies which evaluated discontinuation of and persistence to statins, [21][22][23][24][25]30 discontinuation rates were high overall, persistence to treatment decreased over time, and adherence was in general suboptimal. However, none of these studies assessed the impact of statin intensity.…”

“…4 Nevertheless, there are concerns around the safety of high-intensity statins as high doses may increase the incidence of statin-related side effects such as myopathy, hepatotoxicity or diabetes, [13][14][15] which in turn might impede patients' adherence and persistence to treatment, 16 and subsequently potentially limit the clinical benefit of statins in reducing CVD. [17][18][19][20] This is particularly important given that long-term adherence to statin therapy has already been shown to be far from optimal, [21][22][23][24][25] and a significant proportion of patients stop taking their statins within 2 years of initiation. 22,23 A wide range of factors, related to both the patient and the healthcare provider, has been shown to impact adherence to longterm treatment, for instance insufficient understanding of the disease, concerns about side effects or inconsistent information received from healthcare professionals.…”

“…[17][18][19][20] This is particularly important given that long-term adherence to statin therapy has already been shown to be far from optimal, [21][22][23][24][25] and a significant proportion of patients stop taking their statins within 2 years of initiation. 22,23 A wide range of factors, related to both the patient and the healthcare provider, has been shown to impact adherence to longterm treatment, for instance insufficient understanding of the disease, concerns about side effects or inconsistent information received from healthcare professionals. 26 There is, however, limited and controversial evidence to date with regard to the effect of statin intensity levels on treatment adherence/persistence.…”

Adherence to lipid-lowering guidelines for secondary prevention and potential reduction in CVD events in Swedish primary care: a cross-sectional study

“…23 The probability of persistence has increased over the years but remains low already a few years after initiation of treatment. 24 Since our study is based on an unselected regional primary care patient population, it seems plausible that the results are generalisable to regions and countries with a similar population.…”

Harnessing real-world evidence to reduce the burden of noncommunicable disease: health information technology and innovation to generate insights

“…Therefore, an additional key use of RWE in NCD prevention and control is to better understand how we can improve the complex issues surrounding treatment adherence and persistence (Cramer et al 2008). To address this challenge, RWE can be used to estimate adherence and persistence rates and assess the factors associated with these rates (Chen et al 2019). Such information can be translated into realistic plans based on authentic insights to improve the proportion of patents adherent with their therapeutic regimens.…”