Aims
More optimal dispensing of statins is associated with greater cholesterol lowering;
however, it is not known whether this translates to improved outcomes following acute
coronary syndrome (ACS). The aim of this study was to assess the association between
various levels of statin adherence and outcomes following ACS.
Methods
Patients hospitalised with ACS who underwent coronary angiography between 2014–2018
were identified from the All New Zealand ACS Quality Improvement (ANZACS-QI) registry.
Medication possession ratio (MPR) was used to assess statin adherence and calculated
over 1 year post-discharge using linked pharmaceutical dispensing datasets. Optimal,
adequate and suboptimal adherence was defined as an MPR of ≥1.0, 0.8–0.99 and 0–0.79,
respectively. A combined outcome of all-cause mortality and rehospitalisation for
atherosclerotic disease was identified from 1 year post-discharge through September
2021. Cox proportional hazard models were used to adjust for confounding variables.
Results
Of the 30,452 patients, 68% had optimal adherence, 15% adequate adherence and 16%
had suboptimal adherence to statins. Mean follow-up was 3.6 years. Those with suboptimal
adherence had a higher adjusted risk of the combined outcome compared with those with
optimal adherence (HR 1.18, 95% CI 1.11–1.26). There was no significant difference
in adjusted outcome between those with optimal and adequate adherence (HR 0.99, 95%
CI 0.92–1.06).
Conclusions
Suboptimal statin adherence following ACS is associated with an increased risk of
mortality and rehospitalisation. An MPR cut-off of 0.8 seems reasonable to identify
those at higher risk of cardiovascular events that could benefit the most from interventions
to improve statin adherence and is appropriate as a target for quality improvement
programs.
Keywords
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Article info
Publication history
Published online: January 12, 2023
Accepted:
November 19,
2022
Received in revised form:
October 17,
2022
Received:
May 9,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
