Prescribing of Statins Following ACS in the UK
Prescribing of Statins Following ACS in the UK
The study population included 6,138 ACS cases. Table 1 shows its characteristics at the index date. The majority of ACS cases (64.5%) were men and 55.6% were aged 70 years or older. The discharge diagnosis was troponin positive ACS in 54.4% of the cases, MI with ST elevation in 38.0% and troponin negative in 7.6%. In total, 32.3% of the ACS cases were recorded as using statins at the time of admission. A statin was prescribed at hospital discharge in 90.7% of the ACS cases, while 1.2% had contraindications.
As shown in Table 2 , a large majority of ACS cases were prescribed both a statin at hospital discharge and by their GP (Group 1 representing 81.2% of the ACS cases). Only 340 of the 6,138 ACS cases (5.5%) had no record of statin prescription in either source (Group 4). Elderly ACS cases (aged 80 and over) were less likely to receive a statin at either hospital discharge or general practice compared with patients aged 40–49 years. It was found that there were no major differences between the hospital and general practice in the predictors of statin prescribing following an ACS ( Table 3 ).
Only 30.1% (1,535 of 5,102) of the ACS cases prescribed a statin by their GP received a high-intensity statin dose (54 of these were prescribed simvastatin 80 mg). High-intensity statins were less likely to be prescribed at older ages (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.26–0.48, at age 80+ compared with aged <50 years) and patients with a history of MI were more likely to be prescribed a high-intensity statin (OR 1.44, 95% CI 1.19–1.73) ( Table 4 ). A higher proportion of patients received a higher-intensity statin in the six months post-NICE guidance (33%) compared with the six months before the CG67 guideline was released in May 2008 (26%) (OR 1.38, 95% CI 1.02–1.86).
The majority of ACS cases stopped statin therapy within four years of treatment ( Table 5 ). At year four, only 43% of the ACS cases were still using a statin. Age, gender and dose intensity did not predict long-term persistence to statin therapy. Only a small number of patients switched from high- to low-intensity statin therapy. Of the ACS cases who started on high-intensity statin therapy and persisted, 73% were still using high intensity at year four.
Results
The study population included 6,138 ACS cases. Table 1 shows its characteristics at the index date. The majority of ACS cases (64.5%) were men and 55.6% were aged 70 years or older. The discharge diagnosis was troponin positive ACS in 54.4% of the cases, MI with ST elevation in 38.0% and troponin negative in 7.6%. In total, 32.3% of the ACS cases were recorded as using statins at the time of admission. A statin was prescribed at hospital discharge in 90.7% of the ACS cases, while 1.2% had contraindications.
As shown in Table 2 , a large majority of ACS cases were prescribed both a statin at hospital discharge and by their GP (Group 1 representing 81.2% of the ACS cases). Only 340 of the 6,138 ACS cases (5.5%) had no record of statin prescription in either source (Group 4). Elderly ACS cases (aged 80 and over) were less likely to receive a statin at either hospital discharge or general practice compared with patients aged 40–49 years. It was found that there were no major differences between the hospital and general practice in the predictors of statin prescribing following an ACS ( Table 3 ).
Only 30.1% (1,535 of 5,102) of the ACS cases prescribed a statin by their GP received a high-intensity statin dose (54 of these were prescribed simvastatin 80 mg). High-intensity statins were less likely to be prescribed at older ages (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.26–0.48, at age 80+ compared with aged <50 years) and patients with a history of MI were more likely to be prescribed a high-intensity statin (OR 1.44, 95% CI 1.19–1.73) ( Table 4 ). A higher proportion of patients received a higher-intensity statin in the six months post-NICE guidance (33%) compared with the six months before the CG67 guideline was released in May 2008 (26%) (OR 1.38, 95% CI 1.02–1.86).
The majority of ACS cases stopped statin therapy within four years of treatment ( Table 5 ). At year four, only 43% of the ACS cases were still using a statin. Age, gender and dose intensity did not predict long-term persistence to statin therapy. Only a small number of patients switched from high- to low-intensity statin therapy. Of the ACS cases who started on high-intensity statin therapy and persisted, 73% were still using high intensity at year four.