Adherence to Statins after ACS: What's Your Baseline?
APRIL 21, 2017
Jeannette Y. Wick, RPh, MBA, FASCP
Patients who experience acute coronary syndrome (ACS) need high-intensity statin therapy. Evidence supports its use and shows that it confers a survival benefit. The American Heart Association (AHA) and the American College of Cardiology Foundation (ACCF) acknowledge these findings by incorporating recommendations for high-intensity statin therapy in their guidelines.
It's important to note that more than 90% of patients who experience ACS receive prescriptions for statin therapy; whether they fill the prescriptions or receive a dose that is sufficient enough to confer a benefit is debatable.
A team of researchers from prestigious universities in North Carolina and Tennessee have collaborated to determine if pharmacist intervention regarding guideline-directed statin therapy makes a difference. Their research, published in the May 2017 issue of Annals of Pharmacotherapy, indicates that pharmacist intervention did not significantly increase guideline-directed statin therapy. However, it did seem to increase baseline adherence.
The study included 247 patients who were admitted to a large, academic medical center for ACS. They were divided roughly in half into historical control or pharmacist intervention groups, but the pharmacist intervention group eventually fell to 66 participants after exclusion due to relative contraindications.
The researchers found that after hospital-based emergency care, 81.4% of patients were placed on appropriate statin regimens immediately after their ACS episode.
During hospitalization, an additional 10.8% of patients in the pharmacist intervention group had received statins. In the historical control group, an additional 14.9% of patients received statins.
Adherence to guideline-directed statin therapy was higher in the study than previously documented. It appears that prescribers are adopting the guidelines to a greater extent than previously believed.
Since this study was conducted in a large, academic medical center, it's possible that prescribers were more familiar with guidelines then prescribers at other institutions.
The researchers concluded that individual institutions need to audit their internal guideline adherence to determine if they need pharmacist support to increase guideline-directed statin therapy. Institutions or practices that have lower exposure to clinical pharmacy practices or lower baseline adherence rates to clinical guidelines are likely to benefit more from pharmacist intervention.
Tunney RK Jr, Johnson DC, Wang L, Cox ZL. Impact of pharmacist intervention to increase compliance with guideline-directed statin therapy during an acute coronary syndrome hospitalization. Ann Pharmacother. 2017;51(5):394-400.
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