Abstract
The successful treatment of peripheral arterial disease (PAD) depends on adequate adherence to medications including antiplatelet agents. The aims of this study were (a) to identify the proportion of nonpersistent patients who reinitiated antiplatelet therapy and how many of them discontinued therapy after reinitiation, and (b) to identify patient- and medication-related characteristics associated with the likelihood of reinitiation and discontinuation among reinitiators. The analysis of reinitiation was conducted on 3032 nonpersistent users of antiplatelet agents aged ≥65 years, with PAD newly diagnosed in 2012. Discontinuation (i.e., a treatment gap of ≥6 months without antiplatelet medication prescription) was analysed in 2006 reinitiating patients. To identify factors associated with the likelihood of reinitiation and discontinuation, Cox regression with time-dependent covariates was used. Reinitiation was recorded in 2006 (66.2%) of 3032 patients who had discontinued antiplatelet medication. Among these 2006 reinitiators, 1078 (53.7%) patients discontinued antiplatelet therapy again. Ischemic stroke and myocardial infarction during nonpersistence and bronchial asthma/chronic obstructive pulmonary disease were associated with an increased likelihood of reinitiation. University education was associated with discontinuation among reinitiators. Factors associated with the probability of reinitiation and discontinuation in reinitiators make it possible to identify older PAD patients in whom “stop-starting” behaviour may be expected.
Highlights
Bronchial asthma/chronic obstructive pulmonary disease (COPD) was associated with an increased likelihood of reinitiation of antiplatelet treatment in this study and an increased probability of nonpersistence in our previous study [15]. These results indicate that peripheral arterial disease (PAD) patients with bronchial asthma/COPD tend to discontinue antiplatelet treatment, but after discontinuation they are more likely to reinitiate
Our study revealed a high proportion of reinitiators among PAD patients nonpersistent with antiplatelet medication, and a high proportion of reinitiators who discontinued treatment again
Factors associated with the probability of reinitiation and discontinuation in reinitiators make it possible to identify older PAD patients in whom “stop-starting”
Summary
Peripheral arterial disease (PAD) represents a manifestation of systemic atherosclerosis. PAD refers to atherosclerotic process affecting arteries of the lower limbs. It is estimated that PAD affects 10–15% of the general population. The prevalence of PAD increases with advancing age, reaching more than 20% among persons aged >80 years [1,2,3]. Since atherosclerosis is a generalised process that affects the whole vasculature, PAD is associated with a 6-fold increase in the risk of major adverse cardiovascular (CV) events (nonfatal myocardial infarction (MI), nonfatal stroke, and CV death).
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