Is the KOS-Zawał coordinated care program effective in reducing long-term cardiovascular risk in coronary artery disease patients in Poland? Insights from analysis of statin persistence in a nationwide cohort.

Background: The KOS-Zawał coordinated care (CC) program was introduced in response to challenges in achieving satisfactory survival rates for acute myocardial infarction (AMI) patients in Poland. This system addresses fragmented health delivery for high-risk patients. One of its principal targets is to ensure effective management of dyslipidemia, a critical aspect of secondary prevention, which is often affected by poor adherence.

Aims: We aimed to analyze statin therapy discontinuation among high-risk coronary artery disease (CAD) patients in Poland and assess whether the CC program reduces the chances of non-adherence.

Methods: A retrospective analysis of the nationwide dispensation database covered the period from January 1 to December 31, 2022. Discontinuation was defined as failure to collect a medication within 60 days after the previous supply had run out.

Results: The analysis identified 214 649 high-risk CAD patients. CC turned out to be effective in reducing statin discontinuation risk among post-AMI patients (relative risk [RR] = 0.49; P <0.0001; 95% CI, 0.47-0.51) and in patients after percutaneous coronary intervention (post-PCI)/coronary artery bypass graft (CABG) (RR = 0.68; P <0.0001; 95% CI, 0.66-0.71) as well as all CAD patients (RR = 0.57; P <0.0001; 95% CI, 0.55-0.59). However, statin discontinuation occurred in 1/5, 1/7, and 1/9 of post-AMI, post-PCI/CABG, and all CC patients.

Conclusions: While affirming the efficacy of coordinated care, the results highlight an 11.0% discontinuation rate in this setting, showing a disparity between the recommended therapy and its execution. Therefore, urgent system-wide interventions are needed, including optimising the KOS-Zawał program. Strategic adoption of digital solutions and a dedicated system of alerts for prescribers are potential solutions to address the existing challenges.