Barriers to prescribing proprotein convertase subtilisin-kexin type 9 inhibitors after coronary revascularisation

Jenny Nguy, Sarah A. Hitchen, Nick Lan, Girish Dwivedi, Robert I. Larbalestier, Bu Yeap, Gerry Fegan

Research output: Contribution to journalArticlepeer-review

Abstract

BackgroundGuidelines advocate for intensive lipid-lowering in patients with atherosclerotic cardiovascular disease (ASCVD). In May 2020, evolocumab, a proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor, became government subsidised in Australia for patients with ASCVD requiring further low-density lipoprotein cholesterol (LDL-C) lowering.AimTo identify barriers to prescribing PCSK9 inhibitors in hospitalised patients with ASCVD.MethodsA retrospective three-month, single-site, observational analysis was conducted in consecutive patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Lipid-lowering therapy prescriptions, including PSCK9 inhibitors, were assessed using electronic medical records, compared against the Australian Pharmaceutical Benefits eligibility criteria, and barriers to PCSK9 inhibitor use identified.ResultsOf 331 patients, 244 (73.7%) underwent PCI and 87 (26.3%) underwent CABG surgery. A lipid profile during or within 8 weeks of admission was measured for 202 (82.8%) patients undergoing PCI and 59 (67.8%) undergoing CABG surgery. In patients taking high-intensity statins on admission (n=109), LDL-C ≥1.4, ≥1.8 and >2.6mmol/L were seen in 64 (58.7%), 44 (40.4%) and 19 (17.4%) respectively. High-intensity statin prescribing at discharge was high (>80%); however, ezetimibe was initiated in zero patients with LDL-C ≥1.4mmol/L. There was variable advice given by clinicians for LDL-C targets. No patients met criteria for subsidised PSCK9 inhibitor therapy, largely due to lack of qualifying lipid levels following combined statin and ezetimibe therapy.ConclusionPrescribing of non-statin LDL-C-lowering therapies remains low in patients with ASCVD. Under-prescribing of ezetimibe and suboptimal lipid testing rates are barriers to accessing subsidised PCSK9i therapy using current Australian eligibility criteria. This article is protected by copyright. All rights reserved.
Original languageEnglish
JournalInternal Medicine Journal
DOIs
Publication statusE-pub ahead of print - 3 Feb 2022

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