Abstract 16183: Deleterious Impact of Poor Adherence to Statin Therapy on Long-term Outcomes after Acute Myocardial Infarction: A Nationwide French Survey of Administrative Data.
Aim: To assess the long-term risk of death or recurrent ACS according to adherence to statin therapy in patients discharged on statins after AMI.
Methods: Thirty-month observational follow-up of patients admitted for AMI in France in the first 6 months 2006. Data from three administratives sources were linked for all patients covered by the general health insurance scheme (70% of the French population): the national hospital discharge database, the outpatients medications reimbursement database, and the national mortality database. All patients who filled an initial prescription of statins immediately following hospital discharge and remained in the study after 6-month follow-up (10,501 patients) were included. Adherence was defined as >80% of days of follow-up covered by a filled prescription for statins. ACS-free survival was compared between adherent and non adherent patients, adjusting for sociodemographic and medical factors, using Cox multivariate analysis.
Results: Of the 10,501 patients on statins, 2,515 (24%) were not adherent. Their crude risk of mortality or ACS was 17.7% (95%CI: 16.2%−19.2%) compared to 7.3% (6.7%−7.9%) for adherent patients. After adjustment, the risks were 13.1% (11.8%−14.3%) and 8.1% (7.5%−8.7%), respectively. The adjusted hazard ratio (HR) for death or ACS in patients not adherent to statins was 1.58 (1.37–1.81). In addition, the following covariates were significantly associated with risk of death or ACS: age, cancer, diabetes, renal insufficiency, depression, hospitalization for cardiovascular disease during the 6 months preceding AMI, recognized heart disease entitling to full healthcare coverage before AMI, stent implantation, and coronary artery bypass graft surgery during index admission for AMI, prior use of statins within the 6 months preceding AMI and concomitant use of evidence-based medications. Similar trends were observed for 30-month death and 30-month risk of new ACS.
Conclusions: After AMI, non-adherence to statins is observed in one out of four patients and is associated with a marked decrease in ACS-free survival. Cost-effective strategies for adherence improvement should be developped.
- © 2010 by American Heart Association, Inc.