title: Four out of ten patients are not taking statins regularly during the 12 months after an acute coronary event.
abstract: BACKGROUND
  In New Zealand, a setting in which national guidelines recommend statins for all patients with coronary heart disease (CHD) and cost barriers are low, patterns of use of these drugs are unknown. We investigated dispensing rates after hospital discharge for acute CHD event.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Drug dispensing, hospital diagnosis, and mortality records were linked by unique identifier for all New Zealanders aged 35-84 years after discharge following acute CHD event in 2007. We defined the statin dispensing ratio (SDR) as the proportion of days that 15,506 patients aged 35-84 years were dispensed such agents during the 12 months post discharge. An SDR ≥0.8 (80% or more days covered) was considered optimal.
  
  
  RESULTS
  Overall, 59% of the cohort had an SDR ≥0.8. Of patients dispensed statins in the 3 months before admission (n = 5506), almost all (99%; 5466) continued treatment during follow up and 82% had an SDR ≥0.8. In contrast, for patients not dispensed statins before admission (n = 8014), only two-thirds started statins during follow up and only 44% had an SDR ≥0.8. Of all patients with low statin dispensing (SDR <0.8), about one-quarter were not dispensed any lipid-lowering drugs, one-quarter received alternative lipid-lowering drugs, one-quarter stopped statins, and the remaining quarter were intermittent statin users.
  
  
  CONCLUSIONS
  In a setting with few barriers to statin treatment, about 40% of patients had suboptimal statin dispensing during the year after hospital treatment for CHD. This study has identified four significant categories of suboptimal adherence that could inform quality improvement programmes.
authors: Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand. s.thornley@auckland.ac.nz
authors: Simon
authors: S
authors: Thornley
authors: Roger
authors: R
authors: Marshall
authors: Wing Cheuk
authors: WC
authors: Chan
authors: Andrew
authors: A
authors: Kerr
authors: Jeff
authors: J
authors: Harrison
authors: Gary
authors: G
authors: Jackson
authors: Sue
authors: S
authors: Crengle
authors: Craig
authors: C
authors: Wright
authors: Sue
authors: S
authors: Wells
authors: Rod
authors: R
authors: Jackson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000188:drug therapy* / Q000453:epidemiology; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000639:trends; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D016017:Odds Ratio; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D058996:Quality Improvement / Q000639:trends; D019984:Quality Indicators, Health Care / Q000639:trends; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors