Time trends analysis of statin prescription prevalence, therapy initiation, dose intensity, and utilization from the hospital information system of Jinshan Hospital, Shanghai (2012-2018)

Abstract

Background: Statin remains a mainstay in the prevention and treatment of cardiovascular diseases. Statin utilization has evolved over time in many countries, but data on this topic from China are quite limited. This study aimed to investigate the changing trends of statins prescription, as well as detail the statin utilization through a successive longitudinal study.

Methods: The prescription database was established based on electronic health records retrieved from the hospital information system of Jinshan Hospital, Fudan University from January 2012 to December 2018 in Shanghai, China. The prescription rates and proportions of different statin types and doses among all patients were examined. Sub-analyses were performed when stratifying the patients by age, gender, dose intensity, and preventative intervention.

Results: During the study period, a total of 51,083 patients, who were prescribed for statins, were included in this study (mean [SD] age, 59.78 [±13.16] years; 53.60% male, n = 27, 378). The overall statins prescription rate in which patients increased from 2012 (1.24, 95% CI: 1.21-1.27%) to 2018 (3.16, 95% CI: 3.11-3.20%), P < 0.001. Over 90% of patients were given a moderate dose of statins. Patients with a history of coronary and cerebrovascular events (over 32%) were more likely to be prescribed with statins for preventative intervention. Furthermore, our study has witnessed a significant rise in statin therapy in primary and secondary prevention.

Conclusions: In conclusion, statins were frequently prescribed and steadily increased over time in our study period. There were also changes in statin drug choices and dosages. A coordinated effort among the patient, clinical pharmacist, stakeholders and health system is still needed to improve statin utilization in clinical practice in the future.

Keywords: Cardiovascular disease; Initiation; Prevalence; Preventative intervention; Statins.

Fig. 1

Prescription rate of statins among total statin users (a) and new users (b) from the hospital information system of Jinshan Hospital, Shanghai between 2012 and 2018. The error bars represent the upper and lower bounds of the 95% confidence intervals

Fig. 2

The statin prescription prevalence rates from the hospital information system of Jinshan Hospital, Shanghai (2012–2018). The error bars represent the upper and lower bounds of the 95% confidence intervals. a Overall prevalence rate for the total patients; b prevalence rate stratified according to gender; c prevalence rate stratified according to age

Fig. 3

The new statin user’s initiation rates from the hospital information system of Jinshan Hospital, Shanghai (2013–2018). The error bars represent the upper and lower bounds of the 95% confidence intervals. a Overall initiation rate for the new users; b initiation rate stratified according to gender; c initiation rate stratified according to age

Fig. 4

Prescription rate of statins by intensity between 2012 and 2018 in Jinshan Hospital, Shanghai. The error bars represent the upper and lower bounds of the 95% confidence intervals

Fig. 5

The estimated age-specific prevalence rate (a) for total statin users and imitation rate (b) for new satin users from 2013 to 2018 in Jinshan Hospital, Shanghai, stratified by cardiovascular prevention status and age group. The error bars represent the upper and lower bounds of the 95% confidence intervals

Fig. 6

The initiation rates of new statin users stratified by simvastatin, atorvastatin and rosuvastatin from 2013 to 2018 in Jinshan Hospital, Shanghai. The error bars represent the upper and lower bounds of the 95% confidence intervals