Real-World Prescribing Patterns and Factors Associated with In-Hospital Statin Initiation Among Statin-Naïve Patients...

Background: This study aimed to characterize real-world patterns of in-hospital statin initiation and identify clinical characteristics associated with this prescribing decision among previously statin-naïve patients hospitalized for acute decompensated heart failure (ADHF) in the Polish HEROES registry. Methods: We analyzed 374 statin-naïve patients hospitalized for ADHF, including 168 patients in whom statin therapy was initiated during the index hospitalization and 206 in whom it was not initiated. Demographic, clinical, laboratory, echocardiographic, functional and treatment-related variables were compared between the groups. A prespecified forced-entry multivariable logistic regression model including 10 clinically relevant and nonredundant covariates was used to evaluate factors associated with statin initiation. Results: After multivariable adjustment, higher odds of statin initiation were associated with male sex (adjusted odds ratio [aOR], 2.01; 95% confidence interval [CI], 1.12-3.61), arterial hypertension (aOR, 1.65; 95% CI, 1.06-2.56), previous myocardial infarction (aOR, 1.82; 95% CI, 1.03-3.22), higher systolic blood pressure (aOR per 10 mmHg increase, 1.12; 95% CI, 1.01-1.25), higher LDL-C concentration (aOR per 10 mg/dL increase, 1.15; 95% CI, 1.07-1.22), and anticoagulant therapy (aOR, 1.88; 95% CI, 1.20-2.96). Increasing age (aOR per 1-year increase, 0.97; 95% CI, 0.95-0.99) and a higher KCCQ-12 score (aOR per 10-point increase, 0.88; 95% CI, 0.81-0.96) were associated with lower odds of treatment initiation. LVEF and the GDMT score were not significantly associated with statin initiation. Conclusions: In previously statin-naïve patients hospitalized for ADHF, statin initiation reflected a range of clinical and treatment-related characteristics. These variables should be interpreted as correlates of real-world physician-guided prescribing decisions rather than as causal determinants of statin initiation or predictors of clinical benefit. The study does not provide evidence supporting routine statin initiation solely because of ADHF.