Use of lipid lowering drugs in patients at very high risk of cardiovascular events: An analysis on nearly 3,000,000 Italian subjects of the ARNO Observatory.

AIM: To assess clinical characteristics, use of resources and costs of patients at very high risk (VHR) of cardiovascular (CV) events. Further, to assess how VHR patients are treated with statins (rate of prescription, dosages, adherence).

METHODS AND RESULTS: A record linkage analysis was carried out of patient demographics, drug prescriptions, hospital discharge, specialty procedures from the ARNO Observatory, including 2,989,512 subjects of Local Health Units well representing the whole Italian country. Accrual lasted from January 1 to December 31, 2011. Among these subjects, 17,126 (0.56%) experienced a CV event, representing the cohort at VHR. Between VHR patients, 4810 (28.1%) individuals represent the diabetic cohort. Mean age of VHR patients was 77±13, females were 43.8%. Statins and/or ezetimibe were prescribed in 59.9% and 68.5% during the first year of follow respectively in VHR and VHR-diabetics. Prescription continuity at 1year was 64.7% in patients at VHR, and 63.4% in VHR diabetics. At 1year, at least one re-hospitalization occurred in 55.0% of patients for a total of 17,631 re-hospitalizations. In VHR diabetics, at least one readmission occurred in 59.6% of patients. Average annual cost for a single VHR patient was €11,644 (drugs: €1007; hospitalizations: €10,097; specialty procedures: €540); the corresponding cost for diabetics was €13,199 (drugs: €1394; hospitalizations: €11,032, specialty procedures €773).

CONCLUSIONS: Atherothrombotic events are a relevant cause of hospitalization in the community setting. Prescription rate and continuity of treatment with statins seem to be at least suboptimal. NHS costs are high, with re-hospitalizations being the main cost-driver.