Nonadherence to Statin Therapy: Discontinuation After a Single Fill
Nonadherence to Statin Therapy: Discontinuation After a Single Fill
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DOI：
10.1016/j.cjca.2012.03.018
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发表时间：
2012-09-01
影响因子：
6.2
通讯作者：
Blackburn, David
中科院分区：
文献类型：
--
作者：
Lemstra, Mark;Blackburn, David
简介：众所周知，他汀类药物的依从性并不理想。鲜为人知的是治疗开始后立即停药的比率。本研究的主要目的是确定他汀类药物治疗第一年因单次注射后停药而导致不依从的比例。方法：我们在 9 年期间在低风险（高血压 [HTN]）、中风险（冠心病 [CHD]）和高风险（心力衰竭 [HF]）队列中确定了新的他汀类药物使用者。所有数据均来自行政医疗保健数据库。结果：队列包括 9445 名 HTN、1141 名 CHD 和 778 名 HF 患者。 1 年时，他汀类药物治疗依从性低于 80% 的患者比例分别为 47.9% (HTN)、38.3% (CHD) 和 50.0% (HF)。在所有 1 年时被分类为非依从性的患者中，18.0% 的 HTN、16.3% 的 CHD 和 28.2% 的 HF 患者仅在 1 次配药后就停止了他汀类药物治疗。在开始他汀类药物治疗后 3 个月内，所有非依从性 HTN、CHD 和 HF 患者中分别有 29.7%、40.3% 和 47.5% 停止了新的他汀类药物治疗。经过回归分析，与单次注射后停药一致相关的唯一独立协变量是接受较少的医疗随访。结论：单次注射后立即停药会导致他汀类药物不依从性不成比例。这表明防止不依从的重要时间是治疗开始的第一个月内。
Introduction: Adherence to statin medications is known to be suboptimal. What is less known is the rate of discontinuation immediately after therapy has been initiated. The primary objective of this study was to determine what proportion of nonadherence in the first year of statin therapy was due to discontinuation after a single fill.Methods: We identified new statin users within low-risk (hypertension [HTN]), medium-risk (coronary heart disease [CHD]), and high-risk (heart failure [HF]) cohorts during a 9-year period. All data came from administrative health care databases.Results: The cohorts included 9445 HTN, 1141 CHD, and 778 HF patients. At 1 year, the proportions of patients with less than 80% adherence to statin medications were 47.9% (HTN), 38.3% (CHD), and 50.0% (HF). Among all patients classified as nonadherent at 1 year, 18.0% of HTN, 16.3% of CHD, and 28.2% of HF patients had discontinued statin medications after only 1 dispensation. Within 3 months of starting statin therapy, 29.7%, 40.3%, and 47.5% of all nonadherent HTN, CHD, and HF patients, respectively, had discontinued the new statin medication. After regression analysis, the only independent co-variate that was consistently associated with discontinuation after a single fill was receiving fewer medical follow-up visits.Conclusions: Immediate discontinuation after a single fill contributes disproportionately to statin nonadherence. This suggests an important time to prevent nonadherence is within the first month of treatment initiation.