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Hammer A, Sinkovec H, Todorovic M, Katsch F, Gall W, Duftschmid G, Heinze G, Niessner A, Sulzgruber P. Adherence to Secondary Prevention Measures after Acute Myocardial Infarction and Its Impact on Patient Outcome-A Nationwide Perspective. J Clin Med 2024; 13:4964. [PMID: 39201106 PMCID: PMC11355210 DOI: 10.3390/jcm13164964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/15/2024] [Accepted: 08/20/2024] [Indexed: 09/02/2024] Open
Abstract
Objectives: Secondary prevention is crucial for reducing morbidity and mortality in patients following acute myocardial infraction (MI). However, adherence to cardiac rehabilitation (CR) and pharmacotherapy remains suboptimal despite strong guideline recommendations. This study investigated the adherence to CR, dual antiplatelet therapy (DAPT), and statins following acute MI and evaluated their impact on patient outcomes from a nationwide perspective in Austria. Methods: In this national observational study, all patients diagnosed with acute MI, defined as STEMI or NSTEMI, between April 2011 and August 2015 in Austria were included. Patient characteristics and comorbidities were derived from the Austrian national health insurance system using ICD-10 codes. Adherence to CR, high-intensity statins, and DAPT was assessed based on health insurance records and pharmacy prescription submissions. Cox Regression hazard analysis was used to explore the impact of non-adherence to CR on mortality. Results: Among 16,518 acute MI patients, only 13.4% adhered to the recommended CR programs, which was associated with a significantly lower risk of mortality (adjusted hazard ratio [HR] 0.73; 95% CI: 0.54-0.98; p = 0.036). In contrast, 66.4% of 23,240 patients did not comply with high-intensity statin therapy, correlating with an increased mortality risk (adjusted HR 1.16; 95% CI: 1.06-1.25; p < 0.001). Furthermore, among 22,331 patients analyzed for DAPT adherence, only 29.3% followed the guidelines, yet this adherence was linked to a 21% reduction in mortality over the observation period (adjusted HR 0.79; 95% CI: 0.72-0.88; p < 0.001). Conclusions: This nationwide study reveals alarmingly low adherence to CR and secondary preventive medications among acute MI patients, which is significantly linked to higher mortality rates. Enhanced efforts to promote awareness and adherence are crucial, involving structured referrals and personalized follow-ups to improve patient outcomes. Addressing these gaps through comprehensive healthcare strategies could substantially enhance cardiovascular health.
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Affiliation(s)
- Andreas Hammer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Hana Sinkovec
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Marko Todorovic
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Florian Katsch
- Center for Medical Statistics, Informatics and Intelligent Systems, Department of Medical Information Management, Medical University of Vienna, 1090 Vienna, Austria
| | - Walter Gall
- Center for Medical Statistics, Informatics and Intelligent Systems, Department of Medical Information Management, Medical University of Vienna, 1090 Vienna, Austria
| | - Georg Duftschmid
- Center for Medical Statistics, Informatics and Intelligent Systems, Department of Medical Information Management, Medical University of Vienna, 1090 Vienna, Austria
| | - Georg Heinze
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
- 2nd Department of Medicine with Cardiology and Intensive Care Medicine, Vienna Healthcare Group Clinic Landstrasse, 1030 Vienna, Austria
| | - Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
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Engebretsen I, Bugge C, Støvring H, Husebye E, Sverre E, Dammen T, Halvorsen S, Munkhaugen J. Treatment patterns and adherence to lipid-lowering drugs during eight-year follow-up after a coronary heart disease event. Atherosclerosis 2024; 393:117550. [PMID: 38657552 DOI: 10.1016/j.atherosclerosis.2024.117550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND AIMS Proper prescription and high adherence to intensive lipid lowering drugs (LLD) in patients with coronary heart disease (CHD) are crucial and strongly recommended. The aim of this study is to investigate long-term treatment patterns and adherence to LLD following hospitalization for a CHD event. METHODS Patients admitted to two Norwegian hospitals with a CHD event from 2011 to 2014 (N = 1094) attended clinical examination and completed a questionnaire, median 16 months later. Clinical data were linked to pharmacy dispensing data from 2010 to 2020. The proportions using high-intensity statin therapy (atorvastatin 40/80 mg or rosuvastatin 20/40 mg) and non-statin LLD after the CHD event were assessed. Adherence was evaluated by proportion of days covered (PDC) and gaps in treatment. RESULTS Median age at hospitalization was 63 (IQR 12) years, 21 % were female. Altogether, 1054 patients (96 %) were discharged with a statin prescription, while treatment was dispensed in 85 % within the following 90 days. During median 8 (SD 2.5) years follow-up, the proportion using high-intensity statin therapy ranged 62-68 %, whereas the use of ezetimibe increased from 4 to 26 %. PDC <0.8 was found in 22 % of statin users and 26 % of ezetimibe users. The proportions with a treatment gap exceeding 180 days were 22 % for statins and 28 % for ezetimibe. Smoking at hospitalization and negative affectivity were significantly associated with reduced statin adherence, regardless of adherence measure. CONCLUSIONS In this long-term follow-up of patients with CHD, less than 70 % used high-intensity statin therapy with only small changes over time, and only 25 % used additional treatment with ezetimibe. We identified factors associated with reduced statin adherence that may be target for interventions.
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Affiliation(s)
- Ingrid Engebretsen
- Department of Behavioral Medicine, Faculty of Medicine, University of Oslo, Sognsvannsveien 9, 0372, Oslo, Norway; Oslo Economics, Klingenberggata 7A, 0161, Oslo, Norway; Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 28, 3004, Drammen, Norway.
| | | | - Henrik Støvring
- Oslo Economics, Klingenberggata 7A, 0161, Oslo, Norway; Steno Diabetes Center Aarhus, Paalle Juul-Jensens Blvd. 11, 8200, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000, Aarhus, Denmark; Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 28, 3004, Drammen, Norway
| | - Elise Sverre
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 28, 3004, Drammen, Norway; Department of Cardiology, Oslo University Hospital Ullevål, Kirkeveien 166, 0450, Oslo, Norway
| | - Toril Dammen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway; Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Sognsvannsveien 21, 0372, Oslo, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ullevål, Kirkeveien 166, 0450, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway
| | - John Munkhaugen
- Department of Behavioral Medicine, Faculty of Medicine, University of Oslo, Sognsvannsveien 9, 0372, Oslo, Norway; Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 28, 3004, Drammen, Norway
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Ratz M, Vogel JB, Kührer H, Säly CH, Mündlein A, Vonbank A, Mader A, Fraunberger P, Leiherer A, Drexel H. 25 years of lipid-lowering therapy: secular trends in therapy of coronary patients. Wien Klin Wochenschr 2024:10.1007/s00508-024-02365-x. [PMID: 38743139 DOI: 10.1007/s00508-024-02365-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/05/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND AIM Guidelines on dyslipidemia and lipid-lowering therapy (LLT) over the years recommend lower low-density lipoprotein cholesterol (LDL-C) goals by more intense therapy. Nevertheless, LDL‑C has increased in the general population. Real-world trends of LLT medication as well as of LDL‑C levels in cardiovascular high-risk patients are unclear. METHODS From 2158 patients who were referred for elective coronary angiography, lipid medication was analyzed at admission in three cardiovascular observational studies (OS) over the last 25 years: OS1: 1999-2000, OS2: 2005-2008 and OS3: 2022-2023. The three studies were performed at the same cardiology unit of a tertiary care hospital in Austria. RESULTS The proportion of patients without LLT significantly decreased from OS1 through OS2 to OS3 (49.4%, 45.6%, and 18.5%, respectively, ptrend < 0.001). Moreover, the percentage of patients under high-intensity statin treatment significantly increased from 0% to 5.1%, and 56.5% (ptrend < 0.001). Significantly more patients became treated by more than one compound (OS1: 1.8%, OS2: 1.6%, OS3: 31.2%; ptrend < 0.001). In the latest OS3, a trend to fixed-dose combination of statins with ezetimibe was observed. Mean LDL‑C levels decreased from 129 mg/dL over 127 mg/dL to 83 mg/dL, respectively (ptrend < 0.001). Of the patients on high-intensity therapy 34% met the recent ESC/EAS goals (LDL-C < 55 mg/dL), but only 3% on non-intense therapy. CONCLUSION We conclude that during the observational period of a quarter of a century, treatment intensity increased and LDL‑C levels improved considerably. Guidelines apparently matter in this high-risk population and are considered by primary care physicians.
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Affiliation(s)
- Magdalena Ratz
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
| | - Johannes B Vogel
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
| | - Heike Kührer
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
| | - Christoph H Säly
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Axel Mündlein
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
| | - Alexander Vonbank
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Arthur Mader
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Peter Fraunberger
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
- Central Medical Laboratories, Feldkirch, Austria
| | - Andreas Leiherer
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein.
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria.
- Central Medical Laboratories, Feldkirch, Austria.
| | - Heinz Drexel
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein.
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria.
- Landeskrankenhausbetriebsgesellschaft, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.
- Drexel University College of Medicine, Philadelphia, PA, USA.
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Korsholm MB, Pødenphanth TW, Strømgaard SK, Petersen LW, Alexandersen C, Hoffmann SS, Rasmusen HK, Suetta C, Damgaard K, Pressel E, Dela F. Are statins making older persons weaker? A discontinuation study of muscular side effects. GeroScience 2024; 46:853-865. [PMID: 37225942 PMCID: PMC10828417 DOI: 10.1007/s11357-023-00817-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/02/2023] [Indexed: 05/26/2023] Open
Abstract
Thirteen percent of the Danish population are treated with a statin-half of these are in primary prevention, and most are > 65 years old. Statins have known muscular side effects (i.e., myalgia) correlated to reduced muscle performance. This study examines if years of statin treatment in older people introduce subclinical muscle discomfort and loss of muscle mass and strength. In total, 98 participants (71.1 ± 3.6 years (mean ± SD)), who were in primary prevention treatment for elevated plasma cholesterol with a statin, were included in this study. Statin treatment was discontinued for 2 months and then re-introduced for 2 months. Primary outcomes included muscle performance and myalgia. Secondary outcomes included lean mass and plasma cholesterol. Functional muscle capacity measured as a 6-min walk test increased after discontinuation (from 542 ± 88 to 555 ± 91 m, P < 0.05) and remained increased after re-introduction (557 ± 94 m). Similar significant results were found with a chair stand test (15.7 ± 4.3 to 16.3 ± 4.9 repetitions/30 s) and a quadriceps muscle test. Muscle discomfort during rest did not change significantly with discontinuation (visual analog scale from 0.9 ± 1.7 to 0.6 ± 1.4) but increased (P < 0.05) with the re-introduction (to 1.2 ± 2.0) and muscle discomfort during activity decreased (P < 0.05) with discontinuation (from 2.5 ± 2.6 to 1.9 ± 2.3). After 2 weeks of discontinuation, low-density lipoprotein cholesterol increased from 2.2 ± 0.5 to 3.9 ± 0.8 mM and remained elevated until the re-introduction of statins (P < 0.05). Significant and lasting improvements in muscle performance and myalgia were found at the discontinuation and re-introduction of statins. The results indicate a possible statin-related loss of muscle performance in older persons that needs further examination.
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Affiliation(s)
- Morten Bruun Korsholm
- Department of Geriatric and Palliative Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, NV, Denmark
| | | | - Sofie Kirstine Strømgaard
- Department of Neurology and Geriatrics, Copenhagen University Hospital - Næstved, Slagelse and Ringsted, Slagelse, Denmark
| | - Linda Wiuff Petersen
- Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark
| | - Christina Alexandersen
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Sarah Samama Hoffmann
- Department of Geriatric and Palliative Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, NV, Denmark
- Department of Neurology and Geriatrics, Copenhagen University Hospital - Næstved, Slagelse and Ringsted, Slagelse, Denmark
| | - Hanne K Rasmusen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Charlotte Suetta
- Department of Geriatric and Palliative Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, NV, Denmark
| | - Kirsten Damgaard
- Department of Neurology and Geriatrics, Copenhagen University Hospital - Næstved, Slagelse and Ringsted, Slagelse, Denmark
| | - Eckart Pressel
- Department of Geriatric and Palliative Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, NV, Denmark
| | - Flemming Dela
- Department of Geriatric and Palliative Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, NV, Denmark.
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200, Copenhagen, Denmark.
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Perrone V, Medea G, Urbinati S, Sangiorgi D, Esposti LD. Differenze di genere e ipercolesterolemia: evidenze real-world dallo studio WECARE (Women Effective CArdiovascular Risk Evaluation). GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2024; 11:138-147. [PMID: 38872910 PMCID: PMC11171707 DOI: 10.33393/grhta.2024.2731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/08/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction: The therapeutic control of LDL-cholesterol is essential in cardiovascular prevention, as recommended by the recent guidelines. Objective: To evaluate gender differences in terms of demographic and clinical characteristics, treatment pattern, treatment adherence and healthcare costs in patients on lipid-lowering therapy, stratified by cardiovascular risk in the Italian real clinical practice. Methods: An observational analysis was conducted on the administrative databases of healthcare institutions, covering about 6.1 million health-assisted subjects. After inclusion of all patients on lipid-lowering therapy between January 2017 and June 2020, the population was investigated in the period before the first prescription of a lipid-lowering drug and followed-up for at least 12 months. Clinical and demographic variables were compared after stratification by gender and by cardiovascular risk (very high/high/other risk). The main outcome measures were treatment adherence and direct healthcare costs during follow-up. Results: Of the 684,829 patients with high/very high cardiovascular risk, 337,394 were men and 347,435 women, aged on average 69.3 years and 72.1 years, respectively (p < 0.001). Men were characterised by a worse comorbidity profile. Regardless of cardiovascular risk, female subjects were associated with larger utilisation of low-potency statins and lower adherence (p < 0.001). The annual healthcare costs per patient during follow-up were higher in men than in women (p < 0.001). Conclusions: The results highlighted larger utilisation of low-potency statins, a lower adherence and a milder comorbidity profile in women, the latter feasibly explaining the reduced healthcare costs compared to men.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Bologna - Italy
| | | | | | - Diego Sangiorgi
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Bologna - Italy
| | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Bologna - Italy
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Banach M, Penson PE. Adherence to statin therapy: it seems we know everything, yet we do nothing. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac071. [PMID: 36440352 PMCID: PMC9683386 DOI: 10.1093/ehjopen/oeac071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Rzgowska 281/289, 93-338 Lodz, Poland
- Cardiovascular Research Centre, University of Zielona Gora, Zyty 28, 65-417 Zielona Gora, Poland
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Rzgowska 281/289, 93-338 Lodz, Poland
| | - Peter E Penson
- Clinical Pharmacy & Therapeutics Research Group, School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, UK
- Liverpool Centre for Cardiovascular Science, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK
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