Intensive lipid-lowering therapy in the 12 months after an acute coronary syndrome in Australia: an observational analysis

Abstract

Objective: To determine the prevalence and identify predictors of people hospitalised with acute coronary syndrome (ACS) receiving intensive lipid-lowering therapy during the 12 months after their discharge from hospital.

Design: Retrospective observational analysis.

Setting: Data were extracted from CONCORDANCE, a prospective, Australian investigator-initiated ACS registry.

Participants: Patients enrolled in CONCORDANCE during January 2015 - May 2016 who survived to hospital discharge, for whom information on lipid-lowering therapy 6 or 12 months after discharge from hospital were available.

Main outcome measures: Not receiving intensive lipid-lowering therapy (with or without ezetimibe) at the most recent follow-up (6 or 12 months); predictors of not receiving intensive lipid-lowering therapy.

Results: 1876 of 3441 patients (55%) were receiving intensive lipid-lowering therapy 6 or 12 months after their hospitalisation with an ACS. Predictors of not receiving intensive lipid-lowering therapy included not been prescribed this treatment prior to their hospital admission (odds ratio [OR], 1.53; 95% CI, 1.26-1.85) or at hospital discharge (aOR, 7.24; 95% CI, 4.37-12.0), being a woman (aOR, 1.20; 95% CI, 1.02-1.41), and not being referred for cardiac rehabilitation (aOR 1.39; 95% CI, 1.09-1.78). Patients who were managed medically in hospital (not revascularised; aOR, 1.54; 95% CI, 1.25-1.91) or underwent coronary artery bypass grafting (aOR 1.55; 95% CI, 1.26-1.92) were less likely to be receiving intensive lipid-lowering therapy at follow-up than those with a percutaneous coronary intervention. Unmeasured hospital factors accounted for 17% of the variation in the likelihood of intensive lipid-lowering therapy.

Conclusions: 45% of patients in Australia are not receiving intensive lipid-lowering therapy in the 12 months after their ACS. Optimising oral lipid-lowering therapy would reduce the recurrence of coronary events in this high risk group.

Keywords: Acute coronary syndrome; Lipid regulating agents; Lipids; Registries.