Patterns of statin adherence in primary cardiovascular disease prevention during the pandemic

Abstract

Background: Study of medication adherence patterns can help identify patients who would benefit from effective interventions to improve adherence.Objectives: To identify and compare groups of statin users based on their adherence patterns before and during the COVID-19 pandemic, to characterize the profile of users in each group, and to analyze predictors of distinct adherence patterns.Methods: Participants of the CARhES (CArdiovascular Risk factors for HEalth Services research) cohort, comprising individuals aged >16 years, residing in Aragón (Spain), with hypertension, diabetes mellitus and/or dyslipidemia, took part in this observational longitudinal study. Individuals who began statin therapy during January–June 2019 were selected and followed up until June 2021. Those with a cardiovascular event before or during follow-up were excluded. Data were obtained from healthcare system data sources. Statin treatment adherence during the implementation phase was estimated bimonthly using the Continuous Medication Availability (CMA9) function in the AdhereR package. Group-based trajectory models were developed to group statin users according to their adherence pattern during July 2019–June 2021. Group characteristics were compared and predictors of each adherence pattern were analyzed using multinomial logistic regression.Results: Of 15,332 new statin users, 30.8% had a mean CMA9 ≥80% for the entire study period. Four distinct adherence patterns were identified: high adherence (37.2% of the study population); poor adherence (35.6%); occasional use (14.9%); and gradual decline (12.3%). The latter two groups included users who showed a change in adherence (increase or decrease) during the pandemic emergence. Users with suboptimal adherence were likely to be younger, not pensioners, not institutionalized, with low morbidity burden and a low number of comorbidities. Female sex and switching between statins of different intensity increased the likelihood of belonging to the occasional use group, in which improved adherence coincided with the pandemic.Conclusion: We identified four distinct adherence patterns in a population of new statin users; two of them modified their adherence during the pandemic. Characterization of these groups could enable more effective distribution of resources in future similar crisis and the routine implementation of patient-centered interventions to improve medication adherence.

Impact of COVID-19 epidemic on antihypertensive drug treatment disruptions: results from a nationwide interrupted time-series analysis

“…However, if the impact of the COVID-19 epidemic on interruptions of antihypertensive treatment has been little assessed, several studies have shown a worrying decrease in the use of chronic drugs over the pandemic, in fields as various as mental disorders ( Mansfield et al, 2021 ; Sanchez et al, 2022 ) or diabetes for instance ( Corral-Partearroyo et al, 2022 ; Mathieu et al, 2022 ). Considering more specifically cardiovascular drugs, our results appear consistent with those of a study assessing the impact of the epidemic on adherence to statins ( Malo et al, 2022 ).…”

Invasive Endotyping in Patients With Angina and No Obstructive Coronary Artery Disease: A Randomized Controlled Trial

“…Our hypothesis was that stratified medicine using mechanistically targeted medical therapy would improve modifiable risk factors, such as blood pressure, body mass index, hyperlipidemia, and cigarette smoking. However, most of the patients participated during the COVID-19 pandemic that caused restrictions on access to primary 26,27 and secondary medical care, reduced adherence with medication, 28 reduced control of cardiovascular risk factors, 29,30 and enhanced unfavorable social behaviors. 31 During the pandemic, reduced access undermined the feasibility of medical management in the community.…”

Cohort Profile: The CArdiovascular Risk factors for hEalth Services research (CARhES) cohort study

“…Lastly, it is crucial to recognize the impact of the COVID-19 pandemic on the management and behaviour of individuals with risk factors for CVD. We conducted a study 31 to compare adherence patterns before and during the COVID-19 pandemic among individuals who were first prescribed statins for primary CVD prevention. The study findings revealed the presence of four distinct trajectories of statin adherence across the pandemic.…”