Are high coronary risk patients missing out on lipid-lowering drugs in Australia?

ABSTRACT

OBJECTIVE: To examine whether high coronary risk patients in Australia, where use of lipid-lowering drugs (LLD) is very high by international standards, are receiving LLD. DESIGN, SETTING AND PATIENTS Assessment of Pharmaceutical Benefits Scheme pharmacy payment claim records between January 2006 and May 2013 for a 10% random sample of Australian concession card holders. Co-prescriptions were used as a surrogate for high coronary risk groups - coronary heart disease (CHD) antiplatelet drugs (not including solo aspirin) and anti-anginal drugs; diabetes all standard drugs; hypertension all standard drugs (not including solo diuretics). MAIN OUTCOME MEASURE: Proportions of patients in high-risk groups not receiving LLD (statins, fibrates or ezetimibe). RESULTS: The database yielded information on 276,212 patients defined as being at high coronary risk (mean age, 66.1 [SD, 14.8] years; 44% male). Of this group, 115,477 patients (42%) had not received any LLD during the study period. For patients in the risk group for CHD in combination with diabetes and hypertension, only 8% (1111/14,257) were not receiving LLD. Across all risk groups, the proportions not receiving LLD were generally highest in those aged ≥ 81 years and, to a lesser extent, < 41 years, and were lowest in those aged 51-70 years. CONCLUSION: A large proportion of concession card holders at high coronary risk, especially those in middle age with CHD and multiple risk factors, are being appropriately prescribed LLD in Australia.