Profile of use and access to statins in patients with coronary arterial disease in an outpatient clinic of a teaching hospital

Abstract

Objective

The aim of the study is to describe statin use pattern and access among individuals with coronary artery disease of a secondary care service of the Brazilian Unified Health System.

Methods

This is a cross-sectional study carried out in a multi-professional outpatient cardiology clinic at a public, university, and general hospital in the state of Minas Gerais, Brazil. The level of adherence to the recommendations of intensity of the statin therapy of Brazilian and American dyslipidemia guidelines was established. The prescribed statin, adherence to treatment, access, and clinically relevant drug interactions with statins were identified. Access to statin was analyzed through the availability and acquisition capacity realms.

Results

The sample consisted of 148 patients who were selected from April 2018 to February 2019. Approximately 90% of patients were under 75 years old. The most prevalent cardiovascular diagnoses were acute myocardial infarction with ST-segment elevation and without ST-segment elevation. All patients had a very high cardiovascular risk. Polypharmacy and cardiovascular polypharmacy were identified in 91.2% and 74.3% of patients, respectively. We identified that 90.6% of the patients used a moderate-intensity statin, and simvastatin was the most common stain used. The level of adherence to the recommendations of Brazilian and American dyslipidemia guidelines for statin use was 9.4% and 21.6%, respectively. Total free access to statins by the Unified Health System was 44.6%, with 52.1% of respondents reporting that they received statins at the health center, 25.7% through the popular pharmacy program via copayment, and 33.8% from a private pharmacy.

Conclusion

The level of adherence to the recommendations of U.S. and Brazilian guidelines of dyslipidemia for statin use was low. Most patients used a moderate intensity statin, despite having a high cardiovascular risk. Simvastatin was the most prescribed statin.

Keywords:

• Coronary artery disease
• statin
• hypercholesterolemia
• drug utilization
• health services accessibility

Transparency

Declaration for funding

There is no funding to report for this study.

Declaration of financial/other relationships

The authors have no relevant financial or other relationships to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

None reported.