Key result
Hospitalization in 2010 was associated with a lower 1-year statin discontinuation rate compared to 2007-2008 (17.8% vs 29.5%; OR 0.60; 95% CI 0.51-0.70) in Chinese patients with ACS.
Why the study?
Factors associated with statin discontinuation 1 year post-discharge in patients surviving acute coronary syndrome in China were not well defined.
Cohort (n=10,337)
Yes
Odds Ratio: 0.6 (95% CI 0.51–0.7)
Absolute Event Rate: 17.8% vs 29.5%
Implementing clinical pathways, enhancing medical insurance coverage, and using standard statin dosages are associated with improved 1-year statin adherence in Chinese patients after acute coronary syndrome.
Non-standard statin dosing and absent cholesterol monitoring were associated with higher discontinuation after ACS; leaves open whether targeted interventions improve adherence.
OBJECTIVES: To determine the associated factors for discontinuation of statin use 1 year after discharge in patients who survived from acute coronary syndrome (ACS) in China. SETTINGS: 75 hospitals across China. DESIGN: A cohort follow-up study. PARTICIPANTS: The study included 10 337 patients with ACS hospitalised in 2007-2010 and discharged with statins from 75 hospitals in China in the Clinical Pathways for Acute Coronary Syndromes in China Study-Phase 2 (CPACS-2), who were followed-up at 6 and 12 months postdischarge. PRIMARY OUTCOME MEASURES: The primary outcome was the discontinuation of statin use defined as not in current use of statin at either 6-month or 12-month follow-up. RESULTS: Multivariable logistic regression model showed that patients who did not have cholesterol measurement (adjusted OR=1.29; 95% CI: 1.10 to 1.50) and patients with either higher (1.27; 1.13 to 1.43) or lower dose of statin (1.22; 1.07 to 1.40), compared with those with standard dose, were more likely to discontinue the use of statin. In addition, patients on the CPACS-2 intervention pathway (adjusted OR=0.83; 95% CI: 0.74 to 0.94), patients with medical insurance (0.75; 0.67 to 0.85), history of hypertension (0.83; 0.75 to 0.92), high low-density lipoprotein cholesterol (0.70; 0.57 to 0.87) at the baseline, prior statin use (0.73; 0.63 to 0.84), use of atorvastatin (0.78; 0.70 to 0.88) and those who underwent percutaneous coronary intervention or coronary artery bypass grafting during hospitalisation (0.47; 0.43 to 0.53) were less likely to discontinue statin use. The 1-year statin discontinuation rate decreased from 29.5% in 2007-2008 to 17.8% in 2010 (adjusted OR=0.60; 95% CI: 0.51 to 0.70). CONCLUSION: Implementing clinical pathway, enhancing medical insurance coverage, strengthening health education in both physicians and patients, using statin at standard dosage may help improve the adherence to statin use after discharge in Chinese patients with ACS. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12609000491268).
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Xie et al. (2022) conducted a cohort in Acute coronary syndrome (n=10,337). Hospitalization in 2010 vs. Hospitalization in 2007-2008 was evaluated on Discontinuation of statin use at 6-month or 12-month follow-up (OR 0.60, 95% CI 0.51 to 0.70). Hospitalization in 2010 was associated with a lower 1-year statin discontinuation rate compared to 2007-2008 (17.8% vs 29.5%; OR 0.60; 95% CI 0.51-0.70) in Chinese patients with ACS.
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