Therapeutic Strategies and Health Costs of Patients Admitted for a Cardiovascular Event in Italy

Objectives To assess in a community setting the clinical characteristics, the outcomes and the related costs of patients admitted for an acute coronary syndrome (ACS), or a cerebrovascular disease (CVD), or a peripheral artery disease (PAD). In particular, to assess how patients discharged alive are treated with statins (rate of prescription, dosages, patients’ adherence). Methods A record linkage analysis was carried out of discharge records and prescription data, based on the ARNO Observatory, including 2,989,512 subjects of seven Local Health Units throughout Italy. The accrual period lasted from January 1 to December 31, 2011. The follow-up period was 12 months after the index hospitalization. Results Of the 2,989,512 subjects, 6,226 (2.1%) were hospitalized for ACS, 9,939 (3.3%) for CVD and 1,048 (0.4%) for PAD. The mean age of hospitalized patients was 73 years and males accounted for 56%; diabetes was reported in 28% of patients and in-hospital all-cause death occurred in 5,7%. Of patients discharged alive, 44% were on a statin treatment, of whom 55,2% treated with high dosage statins. In the follow-up period, adherence to treatment was observed in 64.5% of the treated patients. More than half (55.7%) of the discharged patients required readmission. The average annual cost per ACS patient was €14,871 (drugs: €1,315; hospitalizations: €12,836; diagnostics and outpatient visits: €720); the corresponding cost was €9,537 per CVD patient (drugs: €795; hospitalizations: €8,338); and €12,004 per PAD patient (drugs: €1,206; hospitalizations: €9,911). Conclusions Statin prescription rate after a CV event seems to be subottimal. NHS costs are higher for patients with ACS or PAD, with re-hospitalizations during the follow-up period being the main cost-driver.