Transcript Helle Wallach Kildemoes

Helle Wallach Kildemoes, MPH, PhD
Morten Andersen, MD, PhD
Research Unit of General Practice, Institute of Public Health,
University of Southern Denmark
Odense, Denmark
Background
 Statin utilization has increased substantially over the
last decade
Growing evidence of the beneficial effects of statins in a
range of new conditions
Lower out-of-pocket costs
 A prescribing shift in General Practice:
From treatment of post MI patients to
general prevention of cardiovascular disease?
Aim
 To estimate to what extent incident statin
prescribing on new indications accounts for
the growth in statin utilisation
during the last decade
 Analysing prevalence and incidence of
treatment according to indication, age and
gender
A closed Danish cohort
 All Danish inhabitants by January 1 1996
 Statin utilisation among adults were followed
in the registries during 1996-2005
Number (aged >=20)
Died
Emigrated
1996
2005
1996-2005
Male
1.968.825
1.897.087
278.904
83.931
Female
2.064.406
1.975.957
292.851
71.870
All
4.033.231
3.873.044
727.556
Three Registries from Statistics Denmark
Linked by a person code
Drug utilization and hospitalization
At the individual level
Demographic Data
Year of birth, gender, date death/emigration
Nationwide Prescription Registry (1995-2005)
Dispensed out-patient prescriptions
antidiabetics and cardiovascular drugs – including statins
Dispensing date, ATC code
National Patient Registry (1978-2005)
Hospital discharge diagnoses and procedures
Cardiovascular Diseases (CDV), Diabetes
Date, ICD10 /ICD8 codes
Method:
Disease markers for Statin indication
No information about indication for prescribing
Disease markers as a proxy for statin indication
CV conditions: Guideline recommendation for statin
Assuming CV condition with best evidence:
Indication for initiating statin therapy
Combined information from Patient and Prescription Registry
To assign current CVD status for all cohort members
Methods:
Indication hierarchy
Indication / Disease
No prior markers of
(Hospital and prescriptions markers)
1. Myocardial Infarction (MI)
-
2. Ischemic Heart Disease (IHD)
MI
3. Peripheral arterial disease (PAD)
MI, IHD
4. Stroke
MI, IHD, PAD
5. Potential ischemic conditions
(PISC)
MI, IHD, PAD, Stroke
6. Diabetes I & II
MI, IHD, PAD, Stroke, PISC
7. Primary hypertension (HT)
MI, IHD, PA, Stroke, PISC,
diabetes
8. No CVD markers/ CVD risk
MI, IHD, PAD, Stroke, PISC,
diabetes, HT
Prevalence of Statin Users
by Age
Prevalence of Statin Users
by Indication
Incidence of Statin Users
by Indication
Incident Statin Prescribing
by Indication
Incident Statin Prescribing
by Age
Conclusion
 Growing statin utilization reflects the broader range of
condition for initiating statin treatment
 The largest growth in incident statin prescribing was
found among the oldest (75+)
 Half of the growth in incident prescribing between
2000-2005 is explained by treatment among
individuals without prior markers of CVD
The middle-aged at CVD risk carry most weight
 The changing prescribing behaviours among GP’s
- related to the use of the risk score scheme?