Prescription and adherence to statin treatment hold distinct but complementary roles in the beneficial effects due to preventive interventions. We evaluated these parameters in subjects affected by myocardial infarction (MI), correlating such data to re-infarction and total mortality rate. ALARM2 (Adherence to Long-term therapies: Assessment and Real practice Managment - 2) is a prospective investigation carried out in the province of Ferrara (Italy), aiming at evaluating efficacy and costs of HMG-CoA reductase inhibitor utilization. The analysis of the clinical-administrative and prescriptive data-bases of the whole resident population allowed the identification of 1529 subjects (934 men and 595 women) aded more than 18 (72.6+/-13.0 ys., man +/-S.D.), discharged from hospital wards with a disagnosis of MI in three consecutive periods of one year each. Statin prescription and treatment adherence (estimated by the proportion of days covered by treatment) were evaluated inthe following 2 years, together with total mortality and re-infarction rates. For persistent statin users, we categorized patients as adherent if the medication possession ratio was >/=80%. Statin-treated subjects (STS), compared to not-treated ones (NTS), were younger, more frequently males and assuming other cardiovascular drugs. These same characteristics di not discriminate subjects whose adherence in treatment was satisfactory (good adherent subjects, GAS) or insufficient (bad adherent subjects, BAS). After correcting for several confounders (age, gender, cohort, drugs, comorbidity) tal mortality hazard ratio (HR) was 0.438 in BAS and 0.194 in GAS compared to NTS (p<0.001), while HR for reinfarction was 0.396 in BAS and 0.374 in GAS compared to untreated subjects (p<0.01); data were replicated after dichotomizing subjects according to age (less than / more than 80 years). This analysis carried on in non -selected MI subjects, showed better survival and less recurrent ischemic heart disease events related to statin use: to optimize patient oucomes, clinicians should consider clinical and social factors that impact adherence.
Secondary prevention of myocardial infarction and long-term adherence to statin therapy: data from the Alarm2 investigation
SATTA, Elena;VIGNA, Giovanni Battista;VAGNONI, Emidia;
2010
Abstract
Prescription and adherence to statin treatment hold distinct but complementary roles in the beneficial effects due to preventive interventions. We evaluated these parameters in subjects affected by myocardial infarction (MI), correlating such data to re-infarction and total mortality rate. ALARM2 (Adherence to Long-term therapies: Assessment and Real practice Managment - 2) is a prospective investigation carried out in the province of Ferrara (Italy), aiming at evaluating efficacy and costs of HMG-CoA reductase inhibitor utilization. The analysis of the clinical-administrative and prescriptive data-bases of the whole resident population allowed the identification of 1529 subjects (934 men and 595 women) aded more than 18 (72.6+/-13.0 ys., man +/-S.D.), discharged from hospital wards with a disagnosis of MI in three consecutive periods of one year each. Statin prescription and treatment adherence (estimated by the proportion of days covered by treatment) were evaluated inthe following 2 years, together with total mortality and re-infarction rates. For persistent statin users, we categorized patients as adherent if the medication possession ratio was >/=80%. Statin-treated subjects (STS), compared to not-treated ones (NTS), were younger, more frequently males and assuming other cardiovascular drugs. These same characteristics di not discriminate subjects whose adherence in treatment was satisfactory (good adherent subjects, GAS) or insufficient (bad adherent subjects, BAS). After correcting for several confounders (age, gender, cohort, drugs, comorbidity) tal mortality hazard ratio (HR) was 0.438 in BAS and 0.194 in GAS compared to NTS (p<0.001), while HR for reinfarction was 0.396 in BAS and 0.374 in GAS compared to untreated subjects (p<0.01); data were replicated after dichotomizing subjects according to age (less than / more than 80 years). This analysis carried on in non -selected MI subjects, showed better survival and less recurrent ischemic heart disease events related to statin use: to optimize patient oucomes, clinicians should consider clinical and social factors that impact adherence.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
