Abstract
BackgroundPatient reports of their adherence behaviors, concerns about statins, and perceptions of atherosclerotic cardiovascular disease (ASCVD) risk could inform approaches for improving adherence to statin therapy. We examined these factors and their associations with adherence.MethodsWe conducted telephone interviews among a stratified random sample of adults receiving statins within an integrated delivery system (N = 730, 81% response rate) in 2010. We sampled equal numbers of individuals in three clinical risk categories: those with 1) coronary artery disease; 2) diabetes or other ASCVD diagnosis; and 3) no diabetes or ASCVD diagnoses. We assessed 15 potential concerns about and barriers to taking statins, and perceived risk of having a heart attack in the next 10 years (0–10 scale). We calculated the proportion of days covered (PDC) by statins in the last 12 months using dispensing data and used multivariate logistic regression to examine the characteristics associated with non-adherence (PDC<80%). Analyses were weighted for sampling proportions.ResultsSixty-one percent of patients with PDC<50% reported not filling a new prescription, splitting or skipping statins, or stopping refilling statins in the last 12 months vs. 15% of those with PDC≥80% (p<0.05). The most commonly reported concerns about statins were preferring to lower cholesterol with lifestyle changes (66%), disliking medications in general (59%), and liver or kidney problems (31%); having trouble remembering to take statins (9%) was the most common reason for taking less than prescribed. In multivariate analyses, clinical risk categories were not significantly associated with odds of non-adherence; however, those with higher perceived risk of heart attack were less likely to be non-adherent.ConclusionsPatient-reported medication-taking behaviors were correlated with statin PDC and those with lower perceived cardiovascular risk were less likely to be adherent. These findings highlight the importance of eliciting from and educating patients on their adherence behaviors and ASCVD risks.
Highlights
The American College of Cardiology and the American Heart Association (ACC-AHA) released updated guidelines for the management of cholesterol in 2013 expanding the number of individuals for whom statins are recommended for primary prevention.[1]
Editor: Katriina Aalto-Setala, University of Tampere, FINLAND. Patient reports of their adherence behaviors, concerns about statins, and perceptions of atherosclerotic cardiovascular disease (ASCVD) risk could inform approaches for improving adherence to statin therapy
Barriers to adherence to statin therapy data collection and analysis, decision to publish, or preparation of the manuscript
Summary
The American College of Cardiology and the American Heart Association (ACC-AHA) released updated guidelines for the management of cholesterol in 2013 expanding the number of individuals for whom statins are recommended for primary prevention.[1]. A wide-range of approaches to increase statin adherence, including those focused on patient education and support, reminders, and reducing regimen complexity and costs, appear to have significant and positive, but relatively modest effects on adherence.[9,10,11,12,13,14,15] Better tailoring interventions to individual patient adherence behaviors, attitudes, and actual or perceived CVD risk could improve their effectiveness Patient reports of their adherence behaviors, concerns about statins, and perceptions of atherosclerotic cardiovascular disease (ASCVD) risk could inform approaches for improving adherence to statin therapy.
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