Lipid-Lowering Therapy Utilization and Dosage Among Patients with Acute Coronary Syndrome Events: A Retrospective Cohort from 12 Community Hospitals

Abstract

Introduction

Clinical practice guidelines recommend initiating a high-intensity LLT and continued monitoring of low-density lipoprotein cholesterol (LDL-C) following acute coronary syndrome (ACS). We used real-world data to describe LLT utilization after discharge and 1-year adherence. The reduction in LDL-C was also evaluated.

Methods

Data were extracted from electronic health records (EHRs) from 12 hospitals in a large community healthcare system in midwestern United States between 2013 and 2019. Data on eligible patients recently discharged with an ACS event were linked to pharmacy claims data to describe LLT fill rates and 1-year post-discharge adherence. Adherence was reported as the proportion of days covered ≥80%.

Results

Of the 10,589 eligible patients, 49% filled a high-intensity statin at discharge and only 36% were adherent at 1 year. The mean (SD) age was 66.1±13.3, 39.3% were females, 58.8% were Caucasian, and 53.0% had Medicare. There was a clear trend for greater fill rates at discharge among patients with higher LDL-C values than those with lower values (p<0.01). Key predictors of high-intensity (versus medium-intensity) LLT use within 21 days after an ACS event included ACS type (odds ratio [OR] 0.59; 95% confidence interval [CI] 0.52–0.67 for NSTEMI versus STEMI), age group (OR: 0.59; 95% CI: 0.48–0.72 for >75 years versus <65 years), and statin use before index ACS event (OR: 1.56; 95% CI: 1.23–1.88).

Conclusion

This real-world study found that despite recommendations in clinical practice guidelines, high-intensity LLT fill rates at discharge and 1-year adherence to LLT remain suboptimal. Clinical characteristics, including ACS type and LDL-C values, were strong predictors of filling and adherence to guideline-recommended therapy. Age, sex, and race/ethnicity disparities were observed in discharge fill rates and 1-year adherence. These results highlight the need for continued efforts at the patient and provider levels to improve LLT adherence among ACS patients.

Keywords:

• lipid-lowering therapy
• high-intensity statin
• acute coronary syndrome
• real-world data
• prescribing
• adherence

Data Sharing Statement

Data used in this study were derived from the AAH EHR and IQVIA’s Longitudinal Prescription Claims Data.

Acknowledgments

Editorial support was provided by Qais Al-Hadid (Amgen) and Sangeeta P.C. (Cactus Communications).

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

RK, NG, and NS are employees of Advocate Aurora Health and have nothing to disclose. AR is an employee at Cheyenne Regional Medical Group and has nothing to disclose. YL was an employee of Advocate Aurora Health at the time of study initiation and is now an employee of IQVIA and has nothing to disclose. CBM and RLW are employees of IQVIA, which received funding from Amgen to conduct this work. HX was an employee of IQVIA at the time of study initiation and is now an employee of Teva Pharmaceutical Industries Ltd. EJY and BK are employees of Amgen and hold Amgen stock. Neal Sawlani reports personal fees from Edwards Lifesciences, personal fees from Boston Scientific, personal fees from Biotronik, outside the submitted work. The authors report no other conflicts of interest in this work.

Additional information

Funding

This study was sponsored by Amgen Inc. The sponsor contributed to the study design and interpretation of data.