Implications of prescribing a fixed-dose combination in clinical cardiology practice: a retrospective observational study using a single medical centre database in Korea

Abstract

Objective Fixed-dose combination (FDC) prescribing enhances adherence to medication. However, there are limited data regarding the usefulness of FDC drugs across different risk groups. The aim of this study was to explore the relationship between FDC discontinuation and clinical outcomes. Methods From January 2008 to December 2014, patients with FDC prescriptions who visited a cardiology outpatient clinic at a tertiary university hospital in Daegu, Republic of Korea were retrospectively identified. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk score and 20 conventional cardiovascular (CV) risk factors were assessed. Patients were classified according to FDC continuation, together with a tertile of 20 risks. CV events were defined as the composite of admission for worsening heart failure or diabetes, stroke, ischaemic heart disease, and CV death. results 502 patients were prescribed with one of the following FDC products: calcium channel blocker (CCB) plus angiotensin receptor blockers (ARB), CCB plus statins, and ARB plus diuretics. During follow-up (mean 2.8±2.4 years), 203 discontinuations (40.4%) occurred. FDC-discontinued patients had lower ASCVD risk scores (24.8% vs. 28.8%, p<0.001), and patients with <6 risk factors discontinued FDC frequently. During follow-up, 57 events (11.4%) were reported: 30 (14.8%) in FDCdiscontinued patients and 27 (9.1%) in FDC-continued patients (p=0.062). In multivariate models accounting for events, FDC discontinuation (p<0.001) and high ASCVD risk score (p=0.017) were associated with CV events. conclusions FDC discontinuation was common among patients attending the cardiology outpatient clinic. Our analyses suggest that FDC discontinuation in patients at high ASCVD risk may have an impact on CV event rates.

Does the Polypill Improve Patient Adherence Compared to Its Individual Formulations? A Systematic Review

“…Even though this systematic review shows one of the potential benefits of polypill therapy, some of its disadvantages should also be acknowledged. For example, if dosing titration is needed, fixed-dose combination therapy can be inflexible if the appropriate dosage is not available in the form of a polypill [98][99][100][101]. That could lead to exposure of patients to unnecessary therapy and even adverse effects without added benefits [100].…”

Effect of the Polypill on Adherence and Prevention of Cardiovascular Diseases in Patients With or at High Risk of Cardiovascular Diseases: A Meta-Analysis of Randomized Controlled Trials

“…Based on the data currently available on the individual component medications, the polypill may be widely utilized in secondary prevention and by some high-risk adults without CVD. Prolonged therapy can be expected to reduce risk in these patients by 50% to 75% proportionally [ 22 - 23 ]. The findings of this meta-analysis suggest that the polypill can become an important part of strategies to prevent primary and secondary cardiovascular events in patients with or at high risk of CVD.…”