Evaluating statin utilisation in clinical practice in Scotland: impact of statin intensity on adherence and persistence to therapy

Tanja Mueller, Renata Cristina R. Macedo do Nascimento, Marion Bennie, Brian Godman, Simon Hurding, Sean MacBride Stewart, Augusto Afonso Guerra Júnior, Francisco de Assis Acurcio, Alec Morton, Amanj Kurdi

Research output: Contribution to conferenceAbstract

Abstract

Background: Based on recent clinical trial evidence, updated treatment guidelines in the UK recommend high-intensity statin therapy (atorvastatin 80mg) for secondary prevention of cardiovascular disease. However, with this high statin dose, there are concerns about a potential increase in the incidence of statin-related side effects, which might affect patients’ adherence and, in turn, clinical outcomes. Hence, this study aimed to evaluate the effect of statin intensity on adherence and persistence to therapy.
Objectives: To evaluate adherence, discontinuation, and persistence to high-intensity statin in comparison to moderate and low-intensity in Scotland.
Methods: Retrospective cohort study using linked health records. The study population included patients (≥ 18 years) initiated on statins between January 2010 and December 2015. Statin treatment was stratified into high, moderate, and low-intensity based on the current National Institute for Health and Care Excellence classifications. Treatment discontinuation and persistence were evaluated using the refill-gap and anniversary methods, respectively; adherence was assessed by calculating the proportion of days covered (PDC).
Results: A total of 73,716 patients (mean age 62 years [SD 12.6]) initiated statins during the study period: high-intensity n=7,163 (9.7%), moderate-intensity n=65,125 (88.3%), and low-intensity n=1,428 (1.9%). High-intensity therapy was more common among males (10.7%) than females (8.6%), and most common (17.1%) in the youngest age group (18 – 24 years). The majority of patients initiating high-intensity treatment received either atorvastatin 20mg (43.1%) or 40mg (32.3%), while 22.8% received atorvastatin 80mg. Crude discontinuation rates (50.9% high-intensity versus 75.5% low-intensity) and 1-year persistence (74.7% high-intensity versus 53.1% low-intensity) differed significantly between intensity levels; crude adherence (PDC ≥ 80%) was highest among high-intensity patients with 63.7%, compared to 51.6% and 40.5% in moderate and low-intensity, respectively.
Conclusion: Increasing the intensity of statin therapy does not seem to negatively impact adherence and persistence to treatment, although findings could be due to confounders (e.g. primary versus secondary prevention) and/or the low proportion of patients using the recommended high dose statin. Further analysis is ongoing to adjust for confounders, and to evaluate clinical outcomes associated with high-intensity statin therapy.

Conference

Conference34th International Conference on Pharmacoepidemiology and Therapeutic Risk Management
CountryCzech Republic
CityPrague
Period22/08/1826/08/18

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Scotland
Therapeutics
Secondary Prevention
Health
National Institutes of Health (U.S.)
Anniversaries and Special Events
Patient Compliance
Cohort Studies
Cardiovascular Diseases
Retrospective Studies
Age Groups
Clinical Trials

Keywords

  • high-intensity statin therapy
  • cardiovascular disease
  • adherence
  • discontinuation
  • persistence

Cite this

Mueller, T., do Nascimento, R. C. R. M., Bennie, M., Godman, B., Hurding, S., MacBride Stewart, S., ... Kurdi, A. (2018). Evaluating statin utilisation in clinical practice in Scotland: impact of statin intensity on adherence and persistence to therapy. Abstract from 34th International Conference on Pharmacoepidemiology and Therapeutic Risk Management , Prague, Czech Republic.DOI: 10.1002/pds.4629
Mueller, Tanja ; do Nascimento, Renata Cristina R. Macedo ; Bennie, Marion ; Godman, Brian ; Hurding, Simon ; MacBride Stewart, Sean ; Guerra Júnior, Augusto Afonso ; de Assis Acurcio, Francisco ; Morton, Alec ; Kurdi, Amanj. / Evaluating statin utilisation in clinical practice in Scotland : impact of statin intensity on adherence and persistence to therapy. Abstract from 34th International Conference on Pharmacoepidemiology and Therapeutic Risk Management , Prague, Czech Republic.2 p.
@conference{39dfda2dbd4643339be1271d980c2cfd,
title = "Evaluating statin utilisation in clinical practice in Scotland: impact of statin intensity on adherence and persistence to therapy",
abstract = "Background: Based on recent clinical trial evidence, updated treatment guidelines in the UK recommend high-intensity statin therapy (atorvastatin 80mg) for secondary prevention of cardiovascular disease. However, with this high statin dose, there are concerns about a potential increase in the incidence of statin-related side effects, which might affect patients’ adherence and, in turn, clinical outcomes. Hence, this study aimed to evaluate the effect of statin intensity on adherence and persistence to therapy.Objectives: To evaluate adherence, discontinuation, and persistence to high-intensity statin in comparison to moderate and low-intensity in Scotland.Methods: Retrospective cohort study using linked health records. The study population included patients (≥ 18 years) initiated on statins between January 2010 and December 2015. Statin treatment was stratified into high, moderate, and low-intensity based on the current National Institute for Health and Care Excellence classifications. Treatment discontinuation and persistence were evaluated using the refill-gap and anniversary methods, respectively; adherence was assessed by calculating the proportion of days covered (PDC).Results: A total of 73,716 patients (mean age 62 years [SD 12.6]) initiated statins during the study period: high-intensity n=7,163 (9.7{\%}), moderate-intensity n=65,125 (88.3{\%}), and low-intensity n=1,428 (1.9{\%}). High-intensity therapy was more common among males (10.7{\%}) than females (8.6{\%}), and most common (17.1{\%}) in the youngest age group (18 – 24 years). The majority of patients initiating high-intensity treatment received either atorvastatin 20mg (43.1{\%}) or 40mg (32.3{\%}), while 22.8{\%} received atorvastatin 80mg. Crude discontinuation rates (50.9{\%} high-intensity versus 75.5{\%} low-intensity) and 1-year persistence (74.7{\%} high-intensity versus 53.1{\%} low-intensity) differed significantly between intensity levels; crude adherence (PDC ≥ 80{\%}) was highest among high-intensity patients with 63.7{\%}, compared to 51.6{\%} and 40.5{\%} in moderate and low-intensity, respectively.Conclusion: Increasing the intensity of statin therapy does not seem to negatively impact adherence and persistence to treatment, although findings could be due to confounders (e.g. primary versus secondary prevention) and/or the low proportion of patients using the recommended high dose statin. Further analysis is ongoing to adjust for confounders, and to evaluate clinical outcomes associated with high-intensity statin therapy.",
keywords = "high-intensity statin therapy, cardiovascular disease, adherence, discontinuation, persistence",
author = "Tanja Mueller and {do Nascimento}, {Renata Cristina R. Macedo} and Marion Bennie and Brian Godman and Simon Hurding and {MacBride Stewart}, Sean and {Guerra J{\'u}nior}, {Augusto Afonso} and {de Assis Acurcio}, Francisco and Alec Morton and Amanj Kurdi",
year = "2018",
month = "8",
day = "26",
doi = "10.1002/pds.4629",
language = "English",
note = "34th International Conference on Pharmacoepidemiology and Therapeutic Risk Management ; Conference date: 22-08-2018 Through 26-08-2018",

}

Mueller, T, do Nascimento, RCRM, Bennie, M, Godman, B, Hurding, S, MacBride Stewart, S, Guerra Júnior, AA, de Assis Acurcio, F, Morton, A & Kurdi, A 2018, 'Evaluating statin utilisation in clinical practice in Scotland: impact of statin intensity on adherence and persistence to therapy' 34th International Conference on Pharmacoepidemiology and Therapeutic Risk Management , Prague, Czech Republic, 22/08/18 - 26/08/18, . DOI: 10.1002/pds.4629

Evaluating statin utilisation in clinical practice in Scotland : impact of statin intensity on adherence and persistence to therapy. / Mueller, Tanja; do Nascimento, Renata Cristina R. Macedo; Bennie, Marion; Godman, Brian; Hurding, Simon; MacBride Stewart, Sean; Guerra Júnior, Augusto Afonso; de Assis Acurcio, Francisco; Morton, Alec; Kurdi, Amanj.

2018. Abstract from 34th International Conference on Pharmacoepidemiology and Therapeutic Risk Management , Prague, Czech Republic.

Research output: Contribution to conferenceAbstract

TY - CONF

T1 - Evaluating statin utilisation in clinical practice in Scotland

T2 - impact of statin intensity on adherence and persistence to therapy

AU - Mueller,Tanja

AU - do Nascimento,Renata Cristina R. Macedo

AU - Bennie,Marion

AU - Godman,Brian

AU - Hurding,Simon

AU - MacBride Stewart,Sean

AU - Guerra Júnior,Augusto Afonso

AU - de Assis Acurcio,Francisco

AU - Morton,Alec

AU - Kurdi,Amanj

PY - 2018/8/26

Y1 - 2018/8/26

N2 - Background: Based on recent clinical trial evidence, updated treatment guidelines in the UK recommend high-intensity statin therapy (atorvastatin 80mg) for secondary prevention of cardiovascular disease. However, with this high statin dose, there are concerns about a potential increase in the incidence of statin-related side effects, which might affect patients’ adherence and, in turn, clinical outcomes. Hence, this study aimed to evaluate the effect of statin intensity on adherence and persistence to therapy.Objectives: To evaluate adherence, discontinuation, and persistence to high-intensity statin in comparison to moderate and low-intensity in Scotland.Methods: Retrospective cohort study using linked health records. The study population included patients (≥ 18 years) initiated on statins between January 2010 and December 2015. Statin treatment was stratified into high, moderate, and low-intensity based on the current National Institute for Health and Care Excellence classifications. Treatment discontinuation and persistence were evaluated using the refill-gap and anniversary methods, respectively; adherence was assessed by calculating the proportion of days covered (PDC).Results: A total of 73,716 patients (mean age 62 years [SD 12.6]) initiated statins during the study period: high-intensity n=7,163 (9.7%), moderate-intensity n=65,125 (88.3%), and low-intensity n=1,428 (1.9%). High-intensity therapy was more common among males (10.7%) than females (8.6%), and most common (17.1%) in the youngest age group (18 – 24 years). The majority of patients initiating high-intensity treatment received either atorvastatin 20mg (43.1%) or 40mg (32.3%), while 22.8% received atorvastatin 80mg. Crude discontinuation rates (50.9% high-intensity versus 75.5% low-intensity) and 1-year persistence (74.7% high-intensity versus 53.1% low-intensity) differed significantly between intensity levels; crude adherence (PDC ≥ 80%) was highest among high-intensity patients with 63.7%, compared to 51.6% and 40.5% in moderate and low-intensity, respectively.Conclusion: Increasing the intensity of statin therapy does not seem to negatively impact adherence and persistence to treatment, although findings could be due to confounders (e.g. primary versus secondary prevention) and/or the low proportion of patients using the recommended high dose statin. Further analysis is ongoing to adjust for confounders, and to evaluate clinical outcomes associated with high-intensity statin therapy.

AB - Background: Based on recent clinical trial evidence, updated treatment guidelines in the UK recommend high-intensity statin therapy (atorvastatin 80mg) for secondary prevention of cardiovascular disease. However, with this high statin dose, there are concerns about a potential increase in the incidence of statin-related side effects, which might affect patients’ adherence and, in turn, clinical outcomes. Hence, this study aimed to evaluate the effect of statin intensity on adherence and persistence to therapy.Objectives: To evaluate adherence, discontinuation, and persistence to high-intensity statin in comparison to moderate and low-intensity in Scotland.Methods: Retrospective cohort study using linked health records. The study population included patients (≥ 18 years) initiated on statins between January 2010 and December 2015. Statin treatment was stratified into high, moderate, and low-intensity based on the current National Institute for Health and Care Excellence classifications. Treatment discontinuation and persistence were evaluated using the refill-gap and anniversary methods, respectively; adherence was assessed by calculating the proportion of days covered (PDC).Results: A total of 73,716 patients (mean age 62 years [SD 12.6]) initiated statins during the study period: high-intensity n=7,163 (9.7%), moderate-intensity n=65,125 (88.3%), and low-intensity n=1,428 (1.9%). High-intensity therapy was more common among males (10.7%) than females (8.6%), and most common (17.1%) in the youngest age group (18 – 24 years). The majority of patients initiating high-intensity treatment received either atorvastatin 20mg (43.1%) or 40mg (32.3%), while 22.8% received atorvastatin 80mg. Crude discontinuation rates (50.9% high-intensity versus 75.5% low-intensity) and 1-year persistence (74.7% high-intensity versus 53.1% low-intensity) differed significantly between intensity levels; crude adherence (PDC ≥ 80%) was highest among high-intensity patients with 63.7%, compared to 51.6% and 40.5% in moderate and low-intensity, respectively.Conclusion: Increasing the intensity of statin therapy does not seem to negatively impact adherence and persistence to treatment, although findings could be due to confounders (e.g. primary versus secondary prevention) and/or the low proportion of patients using the recommended high dose statin. Further analysis is ongoing to adjust for confounders, and to evaluate clinical outcomes associated with high-intensity statin therapy.

KW - high-intensity statin therapy

KW - cardiovascular disease

KW - adherence

KW - discontinuation

KW - persistence

UR - https://www.pharmacoepi.org/meetings/34icpe/

U2 - 10.1002/pds.4629

DO - 10.1002/pds.4629

M3 - Abstract

ER -

Mueller T, do Nascimento RCRM, Bennie M, Godman B, Hurding S, MacBride Stewart S et al. Evaluating statin utilisation in clinical practice in Scotland: impact of statin intensity on adherence and persistence to therapy. 2018. Abstract from 34th International Conference on Pharmacoepidemiology and Therapeutic Risk Management , Prague, Czech Republic. Available from, DOI: 10.1002/pds.4629