Long-term Persistence in Use of Statin Therapy in Elderly Patients

摘要: ContextKnowledge of long-term persistence with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) therapy is limited because previous studies have observed patients for short periods time, in closely monitored clinical trials, or other unrepresentative settings.ObjectiveTo describe the patterns and predictors with statin an elderly US population.Design, Setting, PatientsRetrospective cohort study including 34 501 enrollees New Jersey Medicaid Pharmaceutical Assistance to Aged Disabled programs who were 65 years age older, initiated statin treatment between 1990 and 1998, who followed up until death, disenrollment, December 31, 1999.Main Outcome MeasuresProportion days covered (PDC) by a each quarter during the first year every 6 months thereafter; suboptimal persistence during interval (PDC <80%) identified using generalized linear models repeated measures.ResultsThe mean PDC was 79% 3 treatment, 56% the second quarter, 42% after 120 months. Only 1 patient 4 maintained a PDC at least 80% 5 years. The proportion less than increased log-linear manner, comprising 40%, 61%, 68% of the 3, 12, months, respectively. Independent predictors of poor included nonwhite race, lower income, older age, less cardiovascular morbidity initiation therapy, depression, dementia, and occurrence coronary heart disease events starting treatment. Patients 1996-1998 21% 25% more likely to have than those started 1990.ConclusionsPersistence older declines substantially over greatest drop occurring treatment. Despite slightly better among began in recent years, use remains low. Interventions are needed early in treatment high-risk groups, experience coronary heart initiating treatment.