Utilisation and maintenance of high-intensity statins following acute coronary syndrome and coronary angiography: opportunities to improve care (ANZACS-QI 26)

AIMS: A key pillar in the medical management of patients after an acute coronary syndrome (ACS) is the early initiation and maintenance of "high-intensity" statin therapy to lower low-density lipoprotein cholesterol (LDL-C) and to improve clinical outcomes. The aim of this study was to describe the New Zealand utilisation of high-intensity statin therapy in the first year post-ACS. METHODS: 19,867 New Zealand patients (>= 20 years), discharged post-ACS event (2015-2017) were identified from the All New Zealand ACS Quality Improvement (ANZACS-QI) registry and anonymously linked with the national pharmaceutical dataset to identify statin dispensing early (0-3 months) and late (9-12 months) post-discharge. "High intensity" statin was subdivided into the New Zealand guidelines recommended dose (80mg atorvastatin) and "other high-intensity" statin (atorvastatin 40mg, simvastatin 80mg). All other statin doses were classified as "low/medium dose". RESULTS: Seventy-nine percent were initially dispensed high-intensity statins. Thirty-six percent of the overall cohort received 80mg atorvastatin and 43% a lower "other high-intensity" statin. A further 13% received a medium/low dose and 8% no statin. By 12 months, 29% were dispensed atorvastatin 80mg, 36% another high dose, 14% a low/medium dose and 21% no statin. Only 14% of those initially on 80mg atorvastatin had a statin dose reduction. After multivariable adjustment, the risk of discontinuation was the same for those started on atorvastatin 80mg compared with "other high dose", and lower than for those started on a low/medium dose. Few patients (6.2%) had statins started, or dose up-titrated post-discharge. There is clinically unexplained variation in the use of the highest atorvastatin 80mg dose between district health boards (range 15% to 65%). CONCLUSIONS: Eight in 10 ACS patients were dispensed a high-intensity statin at discharge, but only 36% received the guidelines-recommended dose of 80mg of atorvastatin. By one year, one in five patients discharged on a statin were not receiving it. There are opportunities to improve longer-term LDL-C reduction and clinical outcomes through dosage optimisation and improved medication maintenance.