Adherence to Antiplatelet Medications among Persistent and Non-Persistent Older Patients with Peripheral Arterial Disease.

Martin Wawruch,Jan Murin,Michal Trnka,Tomas Tesar,Martina Paduchova,Beata Havelkova,Miriam Petrova,Emma Aarnio,Petra Matalova,Denisa Celovska

doi:10.3390/biomedicines9121800

Abstract

Secondary prevention of peripheral arterial disease (PAD) includes administration of antiplatelet agents, and adherence to medication is a requirement for an effective treatment. The aim of this study was to analyse adherence measured using the proportion of days covered (PDC) index separately in persistent and non-persistent patients, and to identify patient- and medication-related characteristics associated with non-adherence in these patient groups. The study cohort of 9178 patients aged ≥ 65 years in whom PAD was diagnosed in 1/–12/2012 included 6146 persistent and 3032 non-persistent patients. Non-adherence was identified as PDC < 80%. Characteristics associated with non-adherence were determined using the binary logistic regression model. In the group of persistent patients, 15.3% of subjects were identified as non-adherent, while among non-persistent patients, 26.9% of subjects were non-adherent to antiplatelet medication. Administration of dual antiplatelet therapy (aspirin and clopidogrel) and a general practitioner as index prescriber were associated with adherence in both patient groups. Our study revealed a relatively high proportion of adherent patients not only in the group of persistent patients but also in the group of non-persistent patients before discontinuation. These results indicate that most non-persistent PAD patients discontinue antiplatelet treatment rapidly after a certain period of adherence.

Highlights

Our study revealed a relatively high proportion of patients with adherence in the group of persistent patients and in the group of non-persistent patients before discontinuation
These results indicate that non-persistent peripheral arterial disease (PAD) patients discontinue antiplatelet treatment rapidly after a certain period of adherence, which may suggest an insufficient awareness of the importance of life-long administration of this medication
Except for bronchial asthma/chronic obstructive pulmonary disease (COPD), only factors associated with adherence were identified in our study

Summary

Introduction

Peripheral arterial disease (PAD) represents a flow-limiting condition caused by narrowing of the peripheral arteries mostly due to atherosclerosis [1]. PAD refers to atherosclerotic disease in the arteries of lower limbs. According to the systematic review and analysis of Fowkes et al [2], 202 million people globally were living with PAD in 2010 and during the preceding decade, the number of subjects with PAD increased by. 28.7% in low or middle-income countries and by 13.1% in high-income countries. PAD incidence and prevalence are sharply age–related, rising >10% among patients in their 60s and 70s [3]. Clinical manifestations of PAD include asymptomatic patients, those with

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