Higher risk of future events, mortality and greater healthcare use among patients with increasingly recurrent atherosclerotic cardiovascular disease events in Taiwan: a retrospective cohort study

Chia-Yun Hsu; Wen-Jone Chen; Hung-Ju Lin; Ho-Min Chen; Yea-Harn Yang; Wei-Ju Chen; Chieh-Min Chen; Fei-Yuan Hsiao

doi:10.1136/bmjopen-2022-064219

Higher risk of future events, mortality and greater healthcare use among patients with increasingly recurrent atherosclerotic cardiovascular disease events in Taiwan: a retrospective cohort study

BMJ Open. 2023 Jul 19;13(7):e064219. doi: 10.1136/bmjopen-2022-064219.

Authors

Chia-Yun Hsu¹, Wen-Jone Chen², Hung-Ju Lin², Ho-Min Chen¹, Yea-Harn Yang³, Wei-Ju Chen³, Chieh-Min Chen⁴, Fei-Yuan Hsiao^{5

6

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Affiliations

¹ Health Data Research Center, National Taiwan University, Taipei, Taiwan.
² Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
³ Amgen Taiwan Limited, Taipei, Taiwan.
⁴ Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁵ Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan fyshsiao@ntu.edu.tw.
⁶ Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
⁷ School of Pharmacy, National Taiwan University, Taipei, Taiwan.

Abstract

Objectives: To describe the occurrence of recurrent atherosclerotic cardiovascular disease (ASCVD) events within 3 years after a new-onset event, the associated disease burden and statin prescribing in patients with ASCVD in Taiwan.

Design: Retrospective cohort study.

Setting: This was a retrospective cohort study using Taiwan's National Health Insurance Research Database.

Participants: In total, 111 399, 133 538 and 21 572 patients who were hospitalised with diagnosis of coronary heart disease (CHD), cerebrovascular disease (CBVD) and peripheral artery disease (PAD), respectively, between 1 January 2012 and 31 December 2014.

Primary and secondary outcome measures: For each index and recurrent event, patients were observed for 12 months after admission to quantify risks of mortality, recurrent events, statin treatment and healthcare use.

Results: We identified 97 321, 120 914 and 14 794 patients with new-onset CHD, CBVD and PAD, respectively. The proportions of developing first, second and third recurrent events were 22.5%, 25.6% and 30.9% for CHD; 20.9%, 26.2% and 32.4% for CBVD and 40.2%, 41.4% and 43.6% for PAD, respectively. Most patients had the same type of ASCVD for their recurrent events as their new-onset event. The mortality rates increased with each recurrent event (p<0.05 for all three ASCVD groups). The rates of hospital readmission and emergency room (ER) visit increased with increasing recurrent events. For example, in the CHD group, the 1-year readmission rates following the index, first and second recurrent events were 43.1%, 47.6% and 55.3%, respectively, and the proportions of visiting ER were 46.4%, 51.9% and 57.8%, respectively. Statin prescribing was suboptimal at time of index event and recurrent events.

Conclusion: Recurrent ASCVD events were associated with a higher risk of recurrent event and mortality and greater healthcare use. However, statin prescriptions at index event and after each recurrent event were suboptimal.

Keywords: cardiac epidemiology; coronary heart disease; epidemiology.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Atherosclerosis* / epidemiology
Cardiovascular Diseases* / epidemiology
Delivery of Health Care
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
Retrospective Studies
Risk Factors
Taiwan / epidemiology

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors