Statin Adherence Research Articles

Adherence to cardiovascular medications and risk of cardiovascular disease in breast cancer patients: A causal inference approach in the Pathways Heart Study

Purpose Women with breast cancer (BC) are at high risk of developing cardiovascular disease (CVD). We examined adherence to CVD medications and their association with major CVD events over 14 years of follow-up in the Pathways Heart Study, a prospective study of 4,776 stage I-III BC patients diagnosed from 2005–2013. Methods Eligibility included being alive 6 months post-BC diagnosis, with dyslipidemia, hypertension, or diabetes at diagnosis along with ≥1 prior outpatient order or dispensing for a statin, anti-hypertensive, or diabetes medication, respectively, in the 30 months prior. Medication adherence was measured from pharmacy data to calculate cumulative average adherence (CAA). Incident heart failure (HF), ischemic heart disease (IHD), and stroke were determined via validated diagnosis and procedure codes. Working marginal structural models (MSM) fitted with inverse probability weighting evaluated the effect of adherence regimens on the hazards for each CVD event, while controlling for baseline and time-varying confounders. MSM parameterizations included: 1) CAA<100% versus CAA = 100% (ref), 2) CAA<80% versus CAA≥80% (ref) and 3) CAA<80% versus 80%≤CAA<100% versus CAA = 100%. Results Poor statin adherence (CAA<80%) was associated with higher risk of composite CVD (HR = 2.54; 95% CI: 1.09, 5.94) versus CAA≥80%. Poor statin adherence was also associated with a higher risk of stroke (HR = 8.13; 95% CI: 2.03, 32.51) but not risk of IHD and HF. Further, compared with perfect adherence (CAA = 100%), good adherence (80%≤CAA<100%) was associated with lower risk (HR = 0.35; 95% CI: 0.13, 0.92) while poor adherence (CAA<80%) was associated with higher risk of composite CVD (HR = 2.45; 95% CI: 1.05, 5.70). Levels of adherence to anti-hypertensives and diabetes medications had mixed or null associations with risk of CVD. Conclusions Maintaining good adherence (≥80%) to statins after BC treatment is beneficial for cardiovascular health in patients with dyslipidemia. Future studies should determine factors associated with lower adherence to statins and ways to improve adherence.

Lipoprotein, Cholesterol, Treatment Strategies, and its Impact on Cardiovascular Diseases

A main cause of death internationally, cardiovascular (CV) illness accounted for about 31.4% of fatalities worldwide in 2012. According to estimates, a 33% decline in coronary heart disease (CHD) mortality in the United States between 1980 and 2000 was caused by a decrease in total cholesterol levels. Similar declines in CHD fatalities (varying from 19% to 46%) in other wealthy nations have been linked to lower total cholesterol levels. Lipoproteins are complex particles with a central core containing cholesterol esters and triglycerides surrounded by free cholesterol, phospholipids, and apolipoproteins, which facilitate lipoprotein formation and function. However, numerous individuals do not achieve LDL-C goal values because of statin resistance or adherence to statin medication. If cholesterol targets are not achieved with statins alone, alternative medicines include ezetimibe, fibrates, and nicotinic acid. In addition, people with familial high cholesterol levels (FH). Lipoprotein may act as a proinflammatory mediator that augments the lesion formation in atherosclerotic plaques. HDL metabolism represents a major target for the development of therapies intended to reduce the risk of atherosclerotic cardiovascular disease. Individual cardiovascular preventative treatments should be targeted largely at individuals at higher risk who will benefit most, with the prevention and treatment of dyslipidemia being viewed as a crucial component of those interventions. Since statins have been demonstrated to lessen the risk of serious vascular events by lowering low-density lipoprotein cholesterol (LDL-C), they continue to be the first-choice medication.

52604 Hyperlipidemia and statin adherence in psoriasis: a population-based study

52604 Hyperlipidemia and statin adherence in psoriasis: a population-based study

Strategies to Address Statin Medication Intolerance Among Patients at Risk of Cardiovascular Disease Identified Through Electronic Health Records: A Literature Review and Pooled Analysis.

Statins are a group of medications that lower lipid and are used for primary and secondary prevention of cardiovascular diseases (CVD). Patients can either be partially (15%) or completely (5%) intolerant to statins. Symptoms of statin intolerance can include muscle aches (myalgia), weakness, cramps, myopathy, diabetes mellitus, and elevated creatine kinase levels. Decreasing statin intolerance also improves statin adherence, which in turn results in lower number of CVD events among patients. Studies on statin intolerance is often embedded within studies of statin adherence. However, relevant data can be obtained from digital health systems. This preliminary literature review looks at studies from the past 10 years to identify and determine the effectiveness of strategies to address statin intolerance. The NLA definition for statin intolerance was used in this review. The initial search results on EMBASE, PubMed, SCOPUS, and CINAHL showed 91 articles and applying the inclusion and exclusion criteria, four articles were used in this review and pooled analysis. The study patients were identified through electronic health records. The pooled analysis was done using the Metafor package in R, applying a random-effect model to estimate pooled effect size. The findings suggest that using fixed dose combination therapy and switching from a lipophilic statin to a hydrophilic statin, while correcting metabolic abnormalities, or initiating evolocumab alongside statin can address statin intolerance. The overall relative risk (RR) was 0.40 (95% CI, 0.09 to 1.70) with I2 90%, and the overall odds ratio (OR) was 0.11 (95% CI, 0.01 to 1.59) with I2 94%, suggesting that the interventions work well in addressing statin intolerance. Since statin intolerance is has a vast range of effects, further research works may be done on exploring the possibility of using digital health systems to identify and provide targeted interventions to patients.

Statin adherence in coronary outpatients: a novel direct method compared with pharmacy registry data

Statin adherence in coronary outpatients: a novel direct method compared with pharmacy registry data

Barriers to Antiplatelet and Statin Adherence Following Major Vascular Intervention

Antiplatelets and statins therapies are associated with improved cardiovascular outcomes following major vascular intervention. Many vascular surgery institutions are reporting improved prescribing rates for aspirin (ASA), P2Y12 antagonists, and statins. Nevertheless, there remains limited publication describing rates and patient-perceived barriers for postoperative adherence. The purpose of this study is to investigate patient nonadherence to antiplatelet and statin therapies following major vascular intervention. A retrospective review of patients who underwent major vascular intervention at a single academic center was performed. The prescribing rates of ASA, P2Y12 antagonists, and statins were reviewed. Postoperative adherence, defined as consistent intake as prescribed, was evaluated at 1, 3, 6, 9, and 12months using electronic documentation of both follow-up clinic appointments and phone call assessments, then corroborated with pharmacy fulfilment records. Patient-reported barriers to medication adherence were also examined. A total of 101 subjects underwent major vascular intervention between January 2020 and July 2020, 98% of whom were discharged on at least 1 antiplatelet or statin agent. Approximately 90% of patients were discharged with ASA, 32% with a P2Y12 antagonist, and 96% with a statin. All patients who maintained adherence up to 6months continued to report adherence at 9 and 12months. Consistent adherence at 12months was documented in 76% of patients on ASA, 81% on P2Y12 antagonism therapy, and 73% on statins. New adverse drug reactions represented the most common barrier to achieving adherence (37% [n=20]). Preoperative therapy with ASA, P2Y12 antagonists, and statins were all independently predictive of postoperative adherence to the same regimen (P≤0.001). The female gender was also associated with higher rates of adherence to postoperative P2Y12 antagonism therapy (P≤0.05). The current prescribing rates for antiplatelet and statin agents are promising, but postoperative nonadherence remains a multifaceted issue.

Adherence with statins and all-cause mortality in days with high temperature.

It has been suggested that statins may exert thermo-protective effects that can reduce mortality on hot days. We aimed to examine the relationship between statin adherence and mortality in days with high temperature. Utilizing data from a prior historical new-user cohort study, we analyzed a cohort of 229 918 individuals within a state-mandated health provider in Israel who initiated statin therapy between 1998 and 2006. Adherence to statins was assessed through the mean proportion of days covered (PDC) with statins during the follow-up period. The study's primary outcome was all-cause mortality during hot days. During the study follow-up period, a total of 13 165 individuals (5.7%) died. In a multivariable model, a 10% increase in PDC with statins was associated with an HR of (0.85; 95% CI: 0.72-1.00) for deaths (n = 16) in extremely hot days (≥39°C). This association was numerically stronger compared to HR = 0.94 (0.93-0.94) in cooler days and displayed a significant difference between sexes. In males, the fully-adjusted HR for a 10% increase in PDC with statins was 0.66 (0.45-0.95), while in women, it was 0.98 (0.78-1.23). In contrast, no such effect modification was observed for death in cooler days. These findings align with earlier research, supporting the notion that adherence with statin treatment may be associated with a reduced risk of death during extremely hot days, particularly among men.

Strategies aiming to improve statin therapy adherence in older adults: a systematic review

BackgroundRandomized clinical trials have shown that, under optimal conditions, statins reduce the risk of cardiovascular events in older adults. Given the prevalence and consequences of suboptimal adherence to statin among older adults, it is essential to document strategies designed to increase statin adherence in this population. The objective of this systematic review is to describe and summarize the effectiveness of interventions to improve statin adherence in older adults (≥ 65 years old).MethodsThis review followed PRISMA guidelines. Studies were identified from PubMed, PsycINFO, Embase, CINAHL and Web of Science. Study selection was conducted independently by four reviewers working in pairs. Included studies reported data on interventions designed to increase adherence to statin therapy in older adults and were original trials or observational studies. Interventions were pragmatically regrouped into 8 different categories going from patient to administrative level. Two reviewers extracted study data and assessed study quality independently. Given the heterogeneity between the included studies, a narrative critique and summary was conducted.ResultsTwelve out of the 2889 identified articles were included in the review. Our review showed that simplifying patients’ drug regimen, administrative improvements and large-scale pharmacy-led automated telephone interventions show positive effects on patient adherence to statin therapy, with odds ratios between > 1.0 and 3.0, while education-based strategies and intensified patient care showed mixed results.ConclusionsCurrent evidence suggests that some interventions can increase statin adherence in older adults, which could help in the reduction of the risk of a cardiovascular event in this population.

Potential impact of blood cholesterol guidelines on statin treatment in the U.S. population using interrupted time series analysis

BackgroundThe 2013 ACC/AHA Guideline was a paradigm shift in lipid management and identified the four statin-benefit groups. Many have studied the guideline’s potential impact, but few have investigated its potential long-term impact on MACE. Furthermore, most studies also ignored the confounding effect from the earlier release of generic atorvastatin in Dec 2011.MethodsTo evaluate the potential (long-term) impact of the 2013 ACC/AHA Guideline release in Nov 2013 in the U.S., we investigated the association of the 2013 ACC/AHA Guideline with the trend changes in 5-Year MACE survival and three other statin-related outcomes (statin use, optimal statin use, and statin adherence) while controlling for generic atorvastatin availability using interrupted time series analysis, called the Chow’s test. Specifically, we conducted a retrospective study using U.S. nationwide de-identified claims and electronic health records from Optum Labs Database Warehouse (OLDW) to follow the trends of 5-Year MACE survival and statin-related outcomes among four statin-benefit groups that were identified in the 2013 ACC/AHA Guideline. Then, Chow’s test was used to discern trend changes between generic atorvastatin availability and guideline potential impact.Results197,021 patients were included (ASCVD: 19,060; High-LDL: 33,907; Diabetes: 138,159; High-ASCVD-Risk: 5,895). After the guideline release, the long-term trend (slope) of 5-Year MACE Survival for the Diabetes group improved significantly (P = 0.002). Optimal statin use for the ASCVD group also showed immediate improvement (intercept) and long-term positive changes (slope) after the release (P < 0.001). Statin uses did not have significant trend changes and statin adherence remained unchanged in all statin-benefit groups. Although no other statistically significant trend changes were found, overall positive trend change or no changes were observed after the 2013 ACC/AHA Guideline release.ConclusionsThe 2013 ACA/AHA Guideline release is associated with trend improvements in the long-term MACE Survival for Diabetes group and optimal statin use for ASCVD group. These significant associations might indicate a potential positive long-term impact of the 2013 ACA/AHA Guideline on better health outcomes for primary prevention groups and an immediate potential impact on statin prescribing behaviors in higher-at-risk groups. However, further investigation is required to confirm the causal effect of the 2013 ACA/AHA Guideline.

Medication adherence star ratings measures, health care resource utilization, and cost.

To examine the association between missed CMS Star Ratings quality measures for medication adherence over 3 years for diabetes, hypertension, and hyperlipidemia medications (9 measures) and health care utilization and relative costs. Retrospective cohort study. The study examined eligible patients who qualified for the diabetes, statin, and renin-angiotensin system antagonist medication adherence measures in 2018, 2019, and 2020 and were continuously enrolled in a Medicare Advantage prescription drug plan from 2017 through 2021. Atotal of 103,900 patients were divided into 4 groups based on the number of adherence measures missed (3 medication classes over 3 years): (1) missed 0 measures, (2) missed 1measure, (3) missed 2 or 3 measures, and (4) missed 4 or more measures. To achieve a quality measure, patients had to meet the Pharmacy Quality Alliance 80% threshold of proportion of days covered during the calendar year. The mean age of the cohort was 71.1 years, and 49.9% were female. Compared with patients who missed 0 of 9 adherence measures, those who missed 1 measure, 2 or 3 measures, and 4 or more measures experienced 12% to 26%, 22% to 42%, and 24% to 50% increased risks, respectively, of all-cause and diabetes-related inpatient stays and all-cause and diabetes-related emergency department visits (all P values < .01). Additionally, patients who missed 1, 2 or 3, and 4 or more adherence measures experienced 14%, 19%, and 20% higher monthly medical costs, respectively. Missing Star Ratings quality measures for medication adherence was associated with an increased likelihood of health care resource utilization and increased costs for patients taking medications to treat diabetes, hypertension, and hyperlipidemia.

Treatment patterns and adherence to lipid-lowering drugs during eight-year follow-up after a coronary heart disease event

Background and aimsProper prescription and high adherence to intensive lipid lowering drugs (LLD) in patients with coronary heart disease (CHD) are crucial and strongly recommended. The aim of this study is to investigate long-term treatment patterns and adherence to LLD following hospitalization for a CHD event. MethodsPatients admitted to two Norwegian hospitals with a CHD event from 2011 to 2014 (N = 1094) attended clinical examination and completed a questionnaire, median 16 months later. Clinical data were linked to pharmacy dispensing data from 2010 to 2020. The proportions using high-intensity statin therapy (atorvastatin 40/80 mg or rosuvastatin 20/40 mg) and non-statin LLD after the CHD event were assessed. Adherence was evaluated by proportion of days covered (PDC) and gaps in treatment. ResultsMedian age at hospitalization was 63 (IQR 12) years, 21 % were female. Altogether, 1054 patients (96 %) were discharged with a statin prescription, while treatment was dispensed in 85 % within the following 90 days. During median 8 (SD 2.5) years follow-up, the proportion using high-intensity statin therapy ranged 62–68 %, whereas the use of ezetimibe increased from 4 to 26 %. PDC <0.8 was found in 22 % of statin users and 26 % of ezetimibe users. The proportions with a treatment gap exceeding 180 days were 22 % for statins and 28 % for ezetimibe. Smoking at hospitalization and negative affectivity were significantly associated with reduced statin adherence, regardless of adherence measure. ConclusionsIn this long-term follow-up of patients with CHD, less than 70 % used high-intensity statin therapy with only small changes over time, and only 25 % used additional treatment with ezetimibe. We identified factors associated with reduced statin adherence that may be target for interventions.

Impact of statin adherence and interruption within 6 months after ST-segment elevation myocardial infarction (STEMI): Results from the real-world regional registry FAST-STEMI

BackgroundThe impact of statin therapy on cardiovascular outcomes after ST-elevation acute myocardial infarction (STEMI) in real- world patients is understudied. AimsTo identify predictors of low adherence and discontinuation to statin therapy within 6 months after STEMI and to estimate their impact on cardiovascular outcomes at one year follow-up. MethodsWe evaluated real-world adherence to statin therapy by comparing the number of bought tablets to the expected ones at 1 year follow-up through pharmacy registries. A total of 6043 STEMI patients admitted from 2012 to 2017 were enrolled in the FAST STEMI registry and followed up for 4,7 ± 1,6 years; 304 patients with intraprocedural and intrahospital deaths were excluded. The main outcomes evaluated were all-cause death, cardiovascular death, myocardial infarction, major and minor bleeding events, and ischemic stroke. The compliance cut-off chosen was 80% as mainly reported in literature. ResultsFrom a total of 5744 patients, 418 (7,2%) patients interrupted statin therapy within 6 months after STEMI, whereas 3337 (58,1%) presented >80% adherence to statin therapy.Statin optimal adherence (>80%) resulted as protective factor towards both cardiovascular (0.1% vs 4.6%; AdjHR 0.025, 95%CI 0.008–0.079, p < 0.001) and all-cause mortality (0.3% vs 13.4%; Adj HR 0.032, 95%CI 0.018–0.059, p < 0.001) at 1 year follow-up. Further, a significant reduction of ischemic stroke incidence (1% vs 2.5%, p = 0.001) was seen in the optimal adherent group. Statin discontinuation within 6 months after STEMI showed an increase of both cardiovascular (5% vs 1.7%; AdjHR 2.23; 95%CI 1.37–3.65; p = 0,001) and all-cause mortality (14.8% vs 5.1%, AdjHR 2.32; 95%CI 1.73–3.11; p 〈0,001) at 1 year follow-up.After multivariate analysis age over 75 years old, known ischemic cardiopathy and female gender resulted as predictors of therapy discontinuation. Age over 75 years old, chronic kidney disease, previous atrial fibrillation, vasculopathy, known ischemic cardiopathy were found to be predictors of low statin adherence. Conclusionsn our real-world registry low statin adherence and discontinuation therapy within 6 months after STEMI were independently associated to an increase of cardiovascular and all-cause mortality at 1 year follow-up. Low statin adherence led to higher rates of ischemic stroke.

Validation of a novel direct method to determine reduced adherence to atorvastatin therapy.

Objective methods to determine statin adherence are requested to improve lipid management. We have recently established a method to detect reduced adherence to atorvastatin therapy with cut-off values based on the sum of atorvastatin and its major metabolites in the blood. We aimed to validate this method in patients with and without cardiovascular disease, and optimize previous cut-off values. The pharmacokinetic study included 60 participants treated with atorvastatin 20mg (N=20), 40mg (N=20), and 80mg (N=20). Atorvastatin was then stopped and blood samples collected from day zero to day four. Quantification of the parent drug and its metabolites in blood plasma was performed with a liquid chromatography-tandem mass spectrometry assay. The cut-off values for reduced adherence were validated and optimized by calculating diagnostic sensitivity and specificity. Our candidate cut-off value of dose-normalized six-component sum of atorvastatin plus metabolites <0.10nM/mg provided a sensitivity of 97% and a specificity of 93% for detecting ≥2 omitted doses. An optimized cut-off <0.062nM/mg provided a sensitivity of 90% and a specificity of 100%. An alternative simplified two-component metabolite sum with a cut-off value <0.05nM/mg provided a sensitivity of 98% and a specificity of 76%. An optimized cut-off <0.02nM/mg provided a sensitivity of 97% and a specificity of 98%. This validation study confirms that our direct method discriminates reduced adherence from adherence to atorvastatin therapy with high diagnostic accuracy. The method may improve lipid management in clinical practice and serve as a useful tool in future studies.

Trends of Lipid Concentrations, Awareness, Evaluation, and Treatment in Severe Dyslipidemia in US Adults

ObjectiveTo evaluate the contemporary trends of lipid concentrations, cholesterol evaluation, hypercholesterolemia awareness, and statin use among individuals with severe dyslipidemia (low-density lipoprotein cholesterol [LDL-C] level ≥190 mg/dL) between 2011 and 2020. Patients and MethodsThis serial cross-sectional analysis included nonpregnant adults ≥20 years of age from the National Health and Nutrition Examination Survey between 2011 and 2020. Age-adjusted weighted trends of LDL-C, triglycerides, cholesterol evaluation in the past 5 years, hypercholesterolemia awareness, and documented statin use among individuals with severe dyslipidemia were estimated. ResultsAmong 24,722 participants included, the prevalence of severe dyslipidemia was 5.4% (SE: 0.2%) which was stable across the study period (Ptrend=.78). Among individuals with severe dyslipidemia (mean age: 55.3 [SE: 0.7] years; 52.2% females; 68.8% non-Hispanic White), LDL-C (224.3 [SE: 4.2] mg/dL in 2011-2012 to 224.2 [SE: 4.6] mg/dL in 2017-2020; Ptrend =.83), and triglyceride (123.3 [SE: 1.1] mg/dL in 2011-2012 to 101.8 [SE: 1.1] mg/dL in 2017-2020; Ptrend=.13), levels remained stable from 2011 to 2020. The rates of cholesterol evaluation in the past 5 years (72.0% [SE: 5.7%] in 2011-2012 to 78.0% [SE: 4.8%] in 2017-2020; Ptrend=.91), hypercholesterolemia awareness (48.1% [SE: 5.5%] in 2011-2012 to 51.9% [SE: 5.8%] in 2017- 2020; Ptrend=.77), and documented statin use (34.7% [SE: 4.5%] in 2011-2012 to 33.4% [SE: 4.0%] in 2017-2020; Ptrend=.28) remained stagnant in individuals with severe dyslipidemia between 2011 and 2020. ConclusionAmong individuals with severe dyslipidemia, cholesterol evaluation and hypercholesterolemia awareness rates were stable at ∼75% and ∼50% in the past decade. Only ∼34% of individuals with severe dyslipidemia took statins between 2011 and 2020, which likely contributed to the stable LDL-C levels noted across the study period. Further investigations into the determinants of statin use and adherence to statins are needed.

Online health information behaviour and its association with statin adherence in patients with high cardiovascular risk: A prospective cohort study.

Statins are effective for preventing cardiovascular disease. However, many patients decide not to take statins because of negative influences, such as online misinformation. Online health information may affect decisions on medication adherence, but measuring it is challenging. This study aimed to examine the associations between online health information behaviour and statin adherence in patients with high cardiovascular risk. A prospective cohort study involving 233 patients with high cardiovascular risk was conducted at a primary care clinic in Malaysia. Participants used a digital information diary tool to record online health information they encountered for 2 months and completed a questionnaire about statin necessity, concerns and adherence at the end of the observation period. Data were analysed using structural equation modelling. The results showed that 55.8% (130 of 233 patients) encountered online health information. Patients who actively sought online health information (91 of 233 patients) had higher concerns about statin use (β = 0.323, p = 0.023). Participants with higher concern about statin use were also more likely to be non-adherent (β = -0.337, p < 0.001). Patients who actively sought online health information were more likely to have lower statin adherence, mediated by higher concerns about statin use (indirect effect, β = -0.109, p = 0.048). Our results suggest that patients with higher levels of concern about statins may be actively seeking online information about statins, and their concerns might influence how they search, what they find, and the potential to encounter misinformation. Our study highlights the importance of addressing patients' concerns about medications to improve adherence.

Factors affecting adherence to medication, smoking cessation, and exercise in patients with peripheral artery disease

ObjectiveAdherence to peripheral artery disease (PAD) treatment reduces the risk of cardiovascular events and delays disease progression, but patients do not fully adhere to their treatment regimens. This pilot study aimed to identify the adherence levels of patients with PAD and how these are related to sociodemographics, clinical factors, and illness perceptions. MethodsPatients with PAD were recruited during outpatient appointments at a London teaching hospital between January and May 2022. Data were collected from medical records and questionnaires, including the self-reported Morinsky Medication Adherence Scale (MMAS-8) and the Brief Illness Perceptions Questionnaire (BIPQ). Descriptive statistics, χ2, independent sample tests, and one-way analysis were conducted using SPSS. ResultsA total of 105 patients participated and completed the questionnaire. Of these, 73.3% were male, with a mean age of 69.5 years. Of the patients, 41.9% and 36.2% had high antiplatelet and statin adherence, respectively, defined by an MMAS >8 score. One-quarter were current smokers, whereas only 17.1% of patients had previously attended a supervised exercise class. High adherence to antiplatelets and statins was associated with older age (P = .006 and P = .047) and previous vascular interventions (P = .004 and P = .009). Low antiplatelet adherence was linked to lower perceived control (P = .041), treatment control (P = .019), and disease understanding (P = .049). Patients perceiving their medical therapy as less effective showed lower statin adherence (P = .036). Being a current or ex-smoker was related to feeling less in control of care (P = .013). High exercise frequency was associated with lower consequences (P = .041) and identity scores (P = .031). Limited walking distance was linked to higher disease impact on daily quality of life (P < .001), lower perceived treatment effectiveness (P = .002), lower perceived personal control (P = .018), severe claudication symptoms (P < .001), and higher concerns (P = .001) and emotional distress (P < .001). ConclusionsTreatment adherence among patients with PAD is notably low. Patients’ illness perceptions play a significant role in understanding and explaining this lack of adherence. To improve treatment adherence, interventions should particularly focus on addressing and modifying negative illness perceptions.

Real world prognostic impact and predictors of adherence to statin therapy after STEMI on first year follow up: results from the FAST STEMI registry

Abstract Background The impact of statin therapy on cardiovascular outcomes after ST-elevation acute myocardial infarction (STEMI) in real-world patients is understudied. Purpose The aim of this study was to identify predictors of low compliance to statin therapy and estimate its impact on cardiovascular (CV) outcomes and mortality in the first year after the index event. Methods We evaluated real-world adherence to the most common cardiovascular drugs by comparing the number of bought tablets in drugstores to the expected tablets at 1 year and on total follow-up length. A total amount of 6043 patients from 2012 to 2017 was enrolled in the FAST STEMI registry and followed up for 4,7±1,6 years; 299 patients with intraprocedural and intrahospital deaths were excluded. The main outcomes evaluated were all-cause death, cardiovascular death, myocardial infarction, major and minor bleeding events and ischemic stroke. The best compliance cut-off was found by ROC curve analysis with Youden index; Kaplan Meier and Cox proportional hazard models were performed to evaluate cumulative event rates of cardiovascular mortality at follow-up. Predictors of lower adherence were evaluated at univariate and multivariate analysis with logistic regression. Results From a total of 5744 patients 4333 were men (75,4%) with an average age of 64,7±12,5 years old; 699 (2,2%) were diabetic, 311 (5,4%) presented with severe chronic kidney disease (CKD) while 237 (4,1%) had previous ischemic cardiopathy disease. Mean statin adherence was 89,9% (IQR 41,1 – 100): after univariate and multivariate analysis age≥75 (OR 0.597, IC 0.514-0.692), previous ischemic stroke (OR 0.607, IC 0.416-0.886), known ischemic cardiopathy (OR 0.675, IC 0.503-0.904) and chronic kidney disease (OR 0.667, IC 0.552-0.879) resulted as predictors of lower compliance, whereas preserved ejection fraction (OR 1.282, IC 1.133-1.457) resulted predictor of adequate adherence to statin therapy. Statin adherence upper than 49.05% (identified at Youden’s analysis as best cut-off) reduced both cardiovascular (0,3% vs. 6,8%; HR 0.33; 95%CI 0.18-0.59; p = 0,001) and all-cause mortality (0,7% vs 18,1%, HR 0,22, 95%CI 0.15-0.37, p&amp;lt;0.001). Regarding cardiovascular outcomes, statin optimal adherence reduced ischemic stroke incidence (1% vs 2,5%, p=0.001) while there was no difference on the number of myocardial infarctions nor hemorrhagic events at 1-year follow up. Conclusions In the real-world setting, statin adherence after STEMI was independently associated to a reduction of cardiovascular mortality, all-cause mortality and ischemic stroke incidence at 1-year follow-up. Elderly age, previous ischemic stroke, known ischemic cardiopathy and CKD resulted as independent predictors of lower compliance to statin therapy.CV and all-cause mortalityCox regression on CV mortality at 1-year

Real-world impact on mortality of drug adherence to statin, beta-blocker and ACEi/ARB therapy in post-STEMI patients with preserved EF: results from the FAST STEMI registry

Abstract Background The impact of drug therapy on cardiovascular outcomes after ST-elevation acute myocardial infarction (STEMI) in patients with preserved ejection fraction (EF) remains unknown. Purpose To identify the impact of drug adherence to statins, ACEi/ARB and beta-blockers on cardiovascular and all-cause mortality at one year after the index event and on total follow-up length in patients affected by STEMI with preserved EF. Methods We evaluated real-world adherence to the most common cardiovascular drugs by comparing the number of tablets purchased inour region drugstores analyzing their registries, to the expected demand of tablets in the follow-up period. A total amount of 6043 patients from 2012 to 2017 was enrolled in the FAST-STEMI registry and followed up for 4,7±1,6 years. Out of these 6043 patients, we excluded 299 patients with intraprocedural and intra-hospital deaths and 2595 patients with reduced or mildly reduced EF. The best compliance cut-off was found by ROC curve analysis with Youden index; Kaplan Meier and Cox proportional hazard models were performed to evaluate cumulative event rates of CV mortality and all-cause mortality at follow-up. Results Of the total 3194 patients were 2396 men (76.1%) with an average age of 63,3±12,1 years old. 318 (10,1%) were diabetic, 115 (3,7%) presented with CKD while 110 (3,5%) had previous CAD. The average adherence after 1 year to beta-blockers was 96,4% (IQR 82,2-100); to statins was 90,4% (IQR 40,3-100) and to ACEi/ARB 87,0% (IQR 61,4-100). At one year, optimal adherence to statin and ACEi/ARB therapy resulted both associated to lower cardiovascular mortality (0% vs 2,9%, p&amp;lt;0.001, and 0,1% vs 1,0%, p=0.001, respectively), as well as all-cause mortality (0,4% vs 9,9%, p&amp;lt;0.001, and 1,0% vs 2,5%, p=0.006 respectively) whereas no difference was seen based on beta-blockers adherence. On an average follow-up length of 4,92±1,35 years ACEi/ARB optimal adherence showed a reduction of both cardiovascular and all-cause death (1,4% vs 2,8%, p=0.036; 7,1% vs 12,4%, p&amp;lt;0.001), statins did not impact on CV mortality but reduced all-cause death (9,3% vs 11,4%, p=0.026) whereas beta-blockers adherence worsened both CV and all-cause mortality (2,5% vs 1,4%, p=0.03; 9,3% vs 7,3%, p=0.04). At multivariate Cox regression analysis ACEi/ARB adherence resulted independent predictor of reduced both CV (HR 0.49 95%CI 0.24-0.98, p=0.045) and all-cause mortality (HR 0.65 95%CI 0.46-0.93, p=0.01), statin adherence resulted independent predictor of reduced all-cause death (HR 0.68; 95% CI 0.47-0.90; p 0.04), though beta-blockers showed a trend of increasing mortality not yet significant. Conclusion In a real-world setting of patients after STEMI with preserved EF, lower ACEi/ARB and statin adherence increased both all-causes death and cardiovascular mortality, whilst the adherence to the beta-blockers seemed to worsen survival at one year and throughout follow-up,yet not significant.

Treatment patterns and adherence to lipid-lowering drugs during 8 years of follow-up after a cardiovascular event

Abstract Introduction In previous research using nationwide prescription data we demonstrated that a considerable proportion of statin users in Norway had treatment gaps or discontinuation in treatment, with 20% of patients having gaps exceeding 180 days. Yet, evidence for treatment practice and long-term adherence to lipid lowering drugs among patients with atherosclerotic cardiovascular disease is limited. Purpose To investigate long-term treatment patterns and adherence to lipid lowering drugs following hospitalization for an acute cardiovascular event. Secondary, to investigate the association between patient characteristics and adherence. Methods Consecutive patients admitted to two hospitals in Norway with acute myocardial infarction or angina undergoing revascularization from 2011-2014 (N=1094) were included in this study. Data on clinical and psychosocial factors were linked to prescription registry data from 2010 to the date of death or end-of follow-up (2020). We evaluated treatment adherence from time of hospital admission to end of follow-up by estimating proportion of days covered (PDC) and gaps in statin treatment. Risk of gaps in statin treatment of &amp;gt;180 days were evaluated across different patient subgroups. Treatment practice after hospital discharge was assessed by the proportion of patients with atorvastatin 40/80 mg or rosuvastatin 20/40 mg, and the proportion of patients with a subsequent ezetimibe prescription. Results Median age was 63 years (SD 9.6) at time of hospital admission. 96% of the patients were discharged with a statin at the index event. During a median of 8 years (SD 2.5) of follow-up, 16% had a gap in their statin treatment exceeding 180 days, and 22% had a PDC &amp;lt; 0.8. LDL-cholesterol target achievement at follow-up was poor and psychosocial distress was prevalent (Table 1). The proportion of patients with gaps ≥180 days was quite similar in all patient subgroups, however somewhat more prevalent among patients who reported statin side-effects (Figure 1). Less than two out of three patients were prescribed high intensity statin therapy during follow-up, while 25% received additional treatment with ezetimibe (Figure 1). Mean number of milligrams redeemed during follow-up was 43 for atorvastatin, 36 for simvastatin and 18 for rosuvastatin. Conclusion In this study of patients hospitalized for an atherosclerotic cardiovascular event, long-term follow-up over 8 years showed that a considerable proportion of patients have poor statin adherence, with gaps in treatment exceeding 180 days. Furthermore, many patients are treated with suboptimal statin therapy, and only 1 out of 4 patients were prescribed ezetimibe. There is a considerable potential for improving long-term adherence and optimizing lipid lowering therapy in secondary prevention.Patient characteristics (N=1094)Proportion of patients with gap&amp;gt;180 days

Statin non-adherence findings from the My Experience of Taking Statin Medicines Questionnaire (mySTATINmed)

Abstract Background Non-­adherence to statins among patients with hyperlipidaemia is estimated to be around 50%. We designed and tested a modified version of the MYMEDS© tool (1), called The My Experience of Taking Statin Medicines (mySTATINmed) questionnaire. The aim was to identify actual and potential modifiable barriers to adherence for use in clinical practice to support patients on statins. Methods The mySTATINmed was integrated within SystmOne, the most commonly used primary care records system in Leeds, and was sent to patients registered with the 32 participating Leeds GP Practices via text message. Patients completed the questionnaire remotely and the response was saved within their medical records. The questionnaire explored patient perspectives on the main modifiable factors that are likely to be associated with statin non­-adherence. Five domains were included within the questionnaire; understanding and satisfaction with statins, concerns, practicalities, fitting the statin into daily routine and self-reported adherence within the last month. Results The mySTATINmed questionnaire was responded by 466 patients [59% males; age mean±SD (range): 65±11 (21-86) years] across 29 GP Practices in Leeds (91% of eligible). There were more males (62% v 55%), but no significant difference in age, in the adherent compared to the non-adherent group. Overall, 57% of patients reported a high level of understanding and satisfaction with statins. Half of the respondents demonstrated some level of concern with their statin treatment. Being on too many medicines concerned 32% of statin users. The news related to statins have affected the perception of 14% of respondents. At least one practical problem was reported by 22% of patients, most commonly because they forget to bring their statin when they travel or leave home. Almost 23% of patients had some level of inconvenience fitting their statin into their daily routine and 21% reported that they sometimes forget to take their statin. The mySTATINmed detected an overall self-reported non-adherence within the last month of treatment of 27%, however 46% of participants displayed some level of actual or potential barriers to adherence based on their responses. Around 36% felt it was not their decision to start their statin and 20% did not have the opportunity to ask questions or openly express concerns. Patients reported not having enough information about expected side effects (43%) and how statins work (41%). Adherent patients consistently demonstrated a better understanding and experience with statins (Table 1). Conclusions The mySTATINmed is a simple tool, integrated within SystmOne, which successfully identified many modifiable actual and potential barriers to statin adherence that can be addressed in clinical practice. It allows generation of longitudinal data, safely stored within individual medical records, to better understand modifiable barriers to statin adherence and non-adherence levels.