Long-term adherence to statins and outcome after acute myocardial infarction: A nationwide French survey of administrative data.

Transcription

1 Long-term adherence to statins and outcome after acute myocardial infarction: A nationwide French survey of administrative data. Anke Neumann, PhD, Philippe Tuppin, MD, Nicolas Danchin, MD, Christine De Peretti, MD, Alain Weill, MD, Philippe Ricordeau, MD, Hubert Allemand, MD Hôpital Européen Georges Pompidou. Paris. France and Département des études sur les pathologies et les patients, direction de la stratégie des études et des statistiques, Caisse nationale d assurance maladie des travailleurs salariés (CNAMTS), Paris, France

2 Background and purpose Multiple trials have documented the benefits of statin therapy in patients with coronary artery disease, including populations with recent myocardial infarction. The aim of this study was to explore the real life relationship between adherence to statins and longterm mortality or readmission for acute coronary syndrome (ACS) after acute myocardial infarction (AMI) in France.

3 Methods (1) The reimbursement database from the general health insurance system (covering 70% of the population) was cross-linked with the French hospital discharge medicoadministrative database. All patients hospitalised for AMI from January 1 st to June 30 th, 2006 and covered by the general health insurance scheme, were followed-up for 30 months. The 10,501 patients who were alive 6 months after the acute episode and had received statin therapy constitute the study population. Data collected: Age, sex, use of coronary angiography, percutaneous coronary interventions (PCI), coronary stent placement, coronary artery bypass graft (CABG) procedures during the index hospital stay or within 30 days of discharge; comorbid conditions Type of health insurance coverage, including LTD for heart disease Major classes of medications reimbursed before and after index episode

4 Methods (2) Definition of adherence to recommended medications: Patients were considered to be adherent to their medications when they had a proportion of days covered by a filled prescription > 80% Two groups of patients. were thus constituted 7,986 patients adherent to statins therapy (76%) 2,515 patients not adherent to statin therapy (24%) Multivariate adjustments: Time to death or readmission for acute coronary syndrome (ACS) was compared. adjusting for these characteristics by multivariate Cox regression. Adjustment for age, sex, comorbid conditions (cancer, diabetes, renal disease, chronic obstructive respiratory disease, depression, inflammatory disease, chronic liver disease, and psychiatric disorders), LTD for heart disease, full health coverage, hospitalization for cardiovascular reasons in the preceding 6 months, concomitant use of beta-blockers, antiplatelet agents, and ACEI/ARB after index event.

5 Results: Univariate correlates of adherence to statins therapy Statin therapy (N=10,501) %Non-Adherent OR for adherence Total 24.0 Age (in years) <= *** >= Gender Female Male Full healthcare coverage for low income patients No Yes Comorbidities : Neoplasia * Diabetes mellitus Renal disease *** Chronic obstructive pulmonary disease Alzheimer s disease Parkinson s disease ** Depression Steroidal or non-steroidal anti-inflammatory use Chronic hepatic disease Psychiatric disorder ** * P < 0,05 ** P < 0,01 *** P < 0,001 P < 0,0001

6 Results: Univariate correlates of adherence to statins therapy Statin therapy (N=10,501) %Non-Adherent OR for adherence Six months prior to index admission LTD for heart disease Prior admission for cardiovascular reason: None Stent implantation * Other CV reasons Prior statin use Index admission for MI No procedures Coronary artery bypass graft Angioplasty without stent implantation *** Stent implantation * P < 0,05 ** P < 0,01 *** P < 0,001 P < 0,0001

7 Results: Multivariate correlates of adherence to statin therapy Adherence to Statin Rx: Adjusted OR Age (in years) <= ** >= Male 1.01 Full healthcare coverage for low income patients 0.59 Comorbidities: Neoplasia 0.88 Diabetes mellitus 0.74 Renal disease 0.75 Chronic obstructive pulmonary disease 1.02 Alzheimer s disease 0.70* Parkinson s disease 0.77 Depression 0.86* Steroidal or non-steroidal antiinflammatory use 1.19 Chronic hepatic disease 1.25 Psychiatric disorder 0.80 Adherence to Statin Rx: Adjusted OR Six months prior to index admission LTD for heart disease 0.68* Prior admission for cardiovascular reason: Stent implantation 1.18 Other diagnoses 0.68* Prior use of statins 1.69* Index admission for MI None 1 Coronary bypass graft 2.25*** Angioplasty without stent 1.17 implantation Stent implantation 1.15 * P < 0,05 ** P < 0,01 *** P < 0,001 P < 0,0001

8 Survival according to adherence to statins Adherent Non adherent Adjusted HR for all-cause death: 1.71 [ ]

9 ACS-free survival Adherence and death or readmission for acute coronary syndrome Adherent Non adherent Adjusted HR for death or ACS: 1.58 [ ]

10 Conclusion After AMI, non-adherence to statins is not unusual (24% in the current population). Non adherence to statin therapy is associated with a marked decrease in overall survival and ACS-free survival, even after multivariate adjustment. Cost-effective strategies for adherence improvement should be developed.