(192) Shifting Patterns in Statin Intensity During Post-Acute Coronary Syndrome Period: An Nationwide Observational Study in Taiwan

Background: Acute Coronary Syndrome (ACS) significantly raises the risk of further cardiovascular events. Effective post-ACS management, particularly through aggressive lipid-lowering treatments such as high-intensity statins, is essential in reducing this risk, especially among patients at very high risk.

Objectives: To evaluate the changes in prescribing patterns of various statin intensities before and after hospitalization for ACS in high-risk groups (HRG) and very high-risk groups (VHRG).

Methods: This study incorporated hospitalized adult patients with a primary diagnosis of ACS between 2016 and 2019 from the Taiwan National Health Insurance Database. Patients who died during hospitalization were excluded. Based on the 2018 AHA/multi-society guidelines, patients were classified into HRG and VHRG. The observation spanned from 180 days before admission to 180 days after discharge, divided into 8 periods: the baseline period, which spanned from 180 days before hospitalization up to the hospital admission date, the hospitalization period itself, and six subsequent post-ACS periods, each consisting of 30 days. During these periods, patients were categorized into high, moderate, low-intensity statin therapy, and non-lipid lowering agents, with deceased or censored patients forming a separate category.

Results: Of the 77,129 eligible patients, 29.5% were in HRG (n=22,725) and 70.5% in VHRG (n=54,404). Initially, non-lipid users (82.7% in HRG, 51.6% in VHRG) and moderate-intensity users (14.4% in HRG, 37.5% in VHRG) predominated in baseline period. During the hospitalization period, high and moderate-intensity statins were used in both groups (HRG- H:38.1%, M:38%; VHRG- H: 29.8%, M: 36.8%). In the 6 post-ACS periods, a majority shifted from high-intensity to moderate-intensity statin use (HRG: 44.8% to 34.7%, VHRG: 37.0% to 28.5%). However, moderate- and low-intensity users generally maintained their original intensity (HRG: 59.2 to 85.5%, VHRG: 73.6 to 84.3%). After the Six months post-ACS, a small percentage used high-intensity statins (HRG: 2.4%, VHRG: 2%), while a larger portion used moderate- (HRG: 45.6%, VHRG: 39.3%) or low-intensity statins (HRG: 13.2%, VHRG: 15.6%), and a significant number did not use any statins for lipid control (HRG: 24.3%, VHRG: 24.8%).

Conclusions: Despite guidelines advocating for aggressive lipid management, a significant shift from high to moderate or low-intensity statin use post-ACS was observed in Taiwan. Most patients did not maintain high-intensity statin therapy, with a marked decrease in usage over six months post-ACS. A considerable number of patients did not use any statins for lipid control, highlighting the need for improved adherence to lipid management guidelines post-ACS to optimize patient outcomes.