Non-Persistence With Antiplatelet Medications Among Older Patients With Peripheral Arterial Disease

Abstract

Introduction: Antiplatelet therapy needs to be administered life-long in patients with peripheral arterial disease (PAD). Our study was aimed at 1) the analysis of non-persistence with antiplatelet medication in older PAD patients and 2) identification of patient- and medication-related characteristics associated with non-persistence.Methods: The study data was retrieved from the database of the General Health Insurance Company. The study cohort of 9,178 patients aged ≥ 65 years and treated with antiplatelet medications was selected from 21,433 patients in whom PAD was newly diagnosed between 01/2012 and 12/2012. Patients with a 6 months treatment gap without antiplatelet medication prescription were classified as non-persistent. Characteristics associated with non-persistence were identified using the Cox regression.Results: At the end of the 5 years follow-up, 3,032 (33.0%) patients were non-persistent. Age, history of ischemic stroke or myocardial infarction, clopidogrel or combination of aspirin with clopidogrel used at the index date, higher co-payment, general practitioner as index prescriber and higher overall number of medications were associated with persistence, whereas female sex, atrial fibrillation, anxiety disorders, bronchial asthma/chronic obstructive pulmonary disease, being a new antiplatelet medication user (therapy initiated in association with PAD diagnosis), and use of anticoagulants or antiarrhythmic agents were associated with non-persistence.Conclusion: In patients with an increased probability of non-persistence, an increased attention should be paid to improvement of persistence.

Reinitiation and Subsequent Discontinuation of Antiplatelet Treatment in Nonpersistent Older Patients with Peripheral Arterial Disease

“…Previously, we carried out a register-based retrospective cohort study which analysed nonpersistence with antiplatelet medications in older PAD patients [ 15 ]. The study cohort consisted of patients aged ≥65 years, with PAD newly diagnosed in 2012, who were administered antiplatelet therapy ( n = 9178).…”

“…The index date of the analysis of reinitiation was the date of the first day of the period of nonpersistence among the 3032 patients who discontinued antiplatelet treatment in our previous study [ 15 ]. Reinitiation was defined as the first prescription of antiplatelet medication after nonpersistence (after the treatment gap).…”

“…Reinitiation was defined as the first prescription of antiplatelet medication after nonpersistence (after the treatment gap). Patients were followed from discontinuation until (a) reinitiation, (b) the end of the 5-year follow-up period of our previous study, which started with the first prescription of antiplatelet agent after the diagnosis of PAD [ 15 ], or (c) death.…”

“…However, factors associated with nonpersistence were not found and the issue of reinitiation was not addressed in that study. In our previous study on nonpersistence with antiplatelet medications in older PAD patients (≥65 years), 33.0% of patients were identified as nonpersistent [ 15 ]. The following patient- and medication-related characteristics were associated with a decreased likelihood of nonpersistence: age, history of ischemic stroke or MI, clopidogrel or combination of aspirin and clopidogrel as the initial antiplatelet medication, higher patient co-payment, general practitioner as index prescriber, and a higher overall number of medications.…”

“…For the reasons mentioned above, we carried out the study presented in this manuscript. The study included two separate analyses: (1) analysis of reinitiation among patients who became nonpersistent with antiplatelet treatment in our previous study [ 15 ], and (2) analysis of discontinuation (nonpersistence) among patients who reinitiated antiplatelet treatment. The aims of these analyses were (a) to identify the proportion of nonpersistent patients who reinitiated antiplatelet therapy and the proportion of reinitiators who discontinued this therapy again after a certain period of persistence, and (b) to identify patient- and medication-related characteristics associated with the likelihood of reinitiation and discontinuation among reinitiators.…”