Meta‐Analysis of Medication Adherence Interventions Among Heart Failure Patients: The Lumpers Make Their Case

Khazanie, Prateeti; Allen, Larry A.

doi:10.1161/jaha.116.003827

JAHA

2016

DOI: 10.1161/jaha.116.003827

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Meta‐Analysis of Medication Adherence Interventions Among Heart Failure Patients: The Lumpers Make Their Case

Prateeti Khazanie

Larry A. Allen

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Cited by 3 publications

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“…For example, one study demonstrated that a year after sustaining an acute myocardial infarction, less than 50% of patients are filling prescriptions for statin, beta‐blocker, and angiotensin‐converting‐enzyme inhibitor medications, even when these medications are offered with no copay . In 2003, a World Health Organization statement noted that improved medication adherence “may have a far greater impact on health … than any improvement in specific medical treatments.” In one study, it was reported that medication adherence interventions among patients with heart failure were found to significantly reduce mortality (relative risk 0.89, 95% CI: 0.81‐0.99) and to decrease odds for hospital readmission (odds ratio 0.79, 95% CI: 0.71‐0.89); however, other studies were more heterogeneous, and not as conclusive . A meta‐analysis regarding adherence to drugs prescribed for the primary or secondary prevention of coronary artery disease showed that approximately one‐third of patients with myocardial infarction and approximately half of patients in primary prevention did not adhere to their medication .…”

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“…7 In one study, it was reported that medication adherence interventions among patients with heart failure were found to significantly reduce mortality (relative risk 0.89, 95% CI: 0.81-0.99) and to decrease odds for hospital readmission (odds ratio 0.79, 95% CI: 0.71-0.89); however, other studies were more heterogeneous, and not as conclusive. 8 A meta-analysis regarding adherence to drugs prescribed for the primary or secondary prevention of coronary artery disease showed that approximately one-third of patients with myocardial infarction and approximately half of patients in primary prevention did not adhere to their medication. 9 This problem is also common in the treatment of other cardiovascular diseases such as heart failure, arrhythmia, and hypertension.…”

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Drugs don’t work in patients who don’t take them

Glasser

2018

J of Clinical Hypertension

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confidence: 99%

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Drugs don’t work in patients who don’t take them

Glasser

2018

J of Clinical Hypertension

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Is Medication Adherence Predictive of Cardiovascular Outcomes and Blood Pressure Control? The Systolic Blood Pressure Intervention Trial (SPRINT)

Glasser

Vitolins

Rocco

et al. 2021

American Journal of Hypertension

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Background Adherence to study medications is crucial to evaluating treatment effects in clinical trials. Objective To assess whether in the SPRINT Trial, adherence and cardiovascular outcomes are associated regardless of intervention assignment. Methods This study included 9361 participants aged ≥ 50 years, recruited from 102 clinics. Participants were randomized to a Standard Treatment Group (targeted SBP <140 mmHg) or an Intensive Treatment Group (targeted SBP <120 mmHg) and followed for incident cardiovascular events until the study was halted early for benefit. The 8-item Morisky Medication Adherence Scale (MMAS-8) was administered at baseline, and at the 12 and 48-month (or close out) visit. Results Adjusting for covariates, there was no association between the baseline 8-item MMAS-8 and the likelihood of the primary composite endpoint, any of the secondary endpoints, or BP control. Low adherence was associated with a higher BMI, SBP, DBP, and PHQ-9, and high adherence was associated with a higher MOCA. There was no difference in the MMAS-8 over time by treatment arm assignment. For the Primary outcome (a composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes), baseline odds ratios (95% confidence intervals) for the Low vs Medium and vs High; and, for Medium vs High MMAS-8 were 1.02 (0.82-1.28), 1.07 (0.85-1.34), and 1.05 (0.88-1.250). Conclusion In SPRINT, medication adherence as measured using the MMAS-8 was not associated with outcomes or BP control.

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Persistence of drug therapy is associated with ischemic stroke and other vascular events in high-risk stroke population

Chen²,

Yu³

et al. 2022

Front. Neurol.

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The high-risk stroke populations are significantly associated with an increased risk of stroke or other vascular events. Although proven primary and secondary stroke prevention medications are available, persistent use is required to be effective. However, the persistence of drug therapy and its association with outcomes in the high-risk stroke population have received limited study in China. Hence, according to the China National Stroke Screening Survey (CNSSS) program in 2015, we performed this multicenter population-based cross-sectional survey and prospective cohort study in Sichuan of southwestern China. The residents aged ≥ 40 years volunteered to participate in a face-to-face survey in 8 communities. Subjects with at least three of eight stroke-related risk factors or a history of stroke were defined as high-risk stroke population. The interviewers recorded individuals' medications at a face-to-face survey, and all the high-risk stroke population was followed up for 4.7 years. The persistence of antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics for stroke was evaluated. The primary outcome was new stroke. Secondary outcomes included new composite vascular events of stroke, myocardial infarction, and death during follow-up periods. Among 16,892 participants, 2,893 (17.1%) participants were high-risk stroke population and 2,698 (93.3%) participants completed to follow-up. The 4.7-year persistence of therapy rate of antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics was 38.0%, 39.9%, 43.9%, and 59.8%, respectively. The total persistence of therapy rate for antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics was 47.6% (136/286) in patients with hypertension, diabetes, dyslipidemia, and stroke at the same time. During the 4.7-year follow-up, there were 118 (4.4%) new ischemic stroke, 24 (0.9%) hemorrhagic stroke, 53 (2.0%) myocardial infarctions, and 33 (1.2%) deaths. After adjusting for the covariates, 4.7-year persistence of antihypertensives, hypoglycemics, lipid-lowering therapy, antithrombotics, and total persistence was independently associated with less new ischemic stroke and less new composite vascular events. Thus, more effective public education and efforts to understand and enhance the persistence of drug therapy are crucial to improve population health and decrease stroke and other vascular events for the high-risk stroke population.

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Meta‐Analysis of Medication Adherence Interventions Among Heart Failure Patients: The Lumpers Make Their Case

Cited by 3 publications

References 16 publications

Drugs don’t work in patients who don’t take them

Drugs don’t work in patients who don’t take them

Is Medication Adherence Predictive of Cardiovascular Outcomes and Blood Pressure Control? The Systolic Blood Pressure Intervention Trial (SPRINT)

Persistence of drug therapy is associated with ischemic stroke and other vascular events in high-risk stroke population

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