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Abstract
Objectives To study patient selection for and persistence with ADP receptor-inhibiting oral antiplatelet (OAP) treatment after acute coronary syndrome (ACS).
Design Observational, retrospective, cohort study linking real-life patient-level register data.
Setting Nationwide drug usage study using data of patients with ACS discharged from hospitals in Finland.
Participants The study population consisted of 54 416 patients (aged ≥18 years) following hospital admission for unstable angina pectoris or myocardial infarction during 2009–2013. Patients were classified as either OAP or non-OAP users based on drug purchases within 7 days of discharge.
Outcome measures Initiation of and a 12-month persistence with OAP medication.
Results In total, 49% of patients with ACS received OAP treatment after hospital discharge. Women represented 40% of the population, but only 32% of them became OAP users (adjusted OR for initiation compared with men 0.8; p<0.001). Patients not treated with percutaneous coronary intervention (PCI), elderly and patients with dementia/Alzheimer's disease, atrial fibrillation or warfarin treatment were less likely to be treated with OAP. If initiated, they were less likely to complete the recommended 12 months’ medication (adjusted risk increment >38% and p<0.001 for all). The OAP users showed good compliance with immediate initiation (92% within 1 day of discharge) and high mean medication possession rate (99%). Among OAP users, the usage of other secondary prevention drugs after ACS was more common than in non-OAP-treated patients (difference >20 percentage points for each).
Conclusions Only half of the patients with ACS received guideline-recommended ADP receptor-inhibiting OAP treatment after hospital discharge, suggesting suboptimal treatment practices. Non-PCI-treated patients and patients with increased age, unstable angina, dementia or atrial fibrillation appear to have the highest risk of deficient treatment with OAPs. OAP users, however, showed good compliance during drug usage.
- oral antiplatelet
- drug utilization
- persistence
- unstable angina pectoris
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Footnotes
Contributors TP has been involved in planning, organisation and execution of the study project. She designed and reviewed statistical analyses, and wrote the manuscript. TP was the principal investigator of the study. HK participated in the planning and execution of the study project. He planned and executed the statistical analyses, and wrote the manuscript. He was the main statistician in this study. AD and PH are representatives of the sponsor. They participated in study planning, statistical analyses review and manuscript writing phases of the study. AD also performed coordination work and PH was involved in designing the statistical work. VK, ER and JA are members of the steering group. They were involved in reviewing results and the manuscript. ER and JA also reviewed the study protocol.
Funding The study was fully sponsored by AstraZeneca Nordic-Baltic.
Competing interests TP and HK are employees of EPID Research, which is a contract research organisation. EPID Research performs commissioned pharmacoepidemiological studies, and thus its employees have been and currently are working in collaboration with several pharmaceutical companies. VK, ER and JA have received fees from pharmaceutical industry for consultancy regarding educational or advisory activities. AD and PH are employees of the sponsor, AstraZeneca Nordic-Baltic.
Ethics approval Ethical Review Board of the Hospital District of Helsinki and Uusimaa, Finland.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The study was conducted by following the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) Code of Conduct and registered into the EUPAS e-register (EUPAS6161). This ensures transparency of the study process including access to full-length study report via ENCePP web pages.