Background
Patients at risk of statin non-adherence are often not identified during hospital
admission with an acute coronary syndrome (ACS).
Methods
In 19,942 patients hospitalised for ACS, statin dispensing was determined from the
national pharmaceutical dispensing database. A risk score for non-adherence was developed
from a multivariable Poisson regression model of associations between risk factors
and the statin Medication Possession Ratio (MPR) <0.8 6–18 months after hospital discharge.
Results
Statin MPR was <0.8 in 4,736 (24%) patients. MPR <0.8 was more likely in patients
with a history of cardiovascular disease (CVD) (RR 3.79, CI 95% 3.42–4.20) and those
without known CVD (RR 2.25, 95% CI 2.04–2.48) who were not taking a statin on ACS
admission, compared to patients with low density lipoprotein (LDL) cholesterol <2
mmol/L who were on a statin. For patients taking a statin on admission, higher LDL
was associated with MPR <0.8 (≥3 versus <2 mmol/L, RR 1.96, 95%CI 1.72–2.24). Other
independent risk factors for MPR <0.8 were age <45 years, female, disadvantaged ethnic
groups, and no coronary revascularisation during the ACS admission. The risk score,
which included nine variables, had a C-statistic of 0.67. MPR was <0.8 in 12% of 5,348
patients with a score ≤5 (lowest quartile) and 45% of 5,858 patients with a score
≥11 (highest quartile).
Conclusion
A risk score generated from routinely collected data predicts statin non-adherence
in patients hospitalised with ACS. This may be used to target inpatient and outpatient
interventions to improve medication adherence.
Keywords
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Article info
Publication history
Published online: March 16, 2023
Accepted:
January 25,
2023
Received in revised form:
December 20,
2022
Received:
August 25,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 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.
