Predictors of first‐year nonadherence and discontinuation of statins among older adults: a retrospective cohort study

Ofori‐Asenso, Richard; Ilomäki, Jenni; Tacey, Mark; Si, Si; Curtis, Andrea J.; Zomer, Ella; Bell, Jane; Zoungas, Sophia

doi:10.1111/bcp.13797

Cited by 40 publications

(43 citation statements)

References 47 publications

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“…Our findings are consistent with previous studies which have shown associations between polypharmacy12 30 and increased comorbidities25 and reduced risk of non-adherence or non-persistence for OACs and other cardiovascular medications. Understanding each of the multiple steps in the prescription-persistence cascade may aid design and implementation of better interventions to improve drug utilisation.…”

Section: Discussionsupporting

confidence: 93%

Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study

Banerjee

Benedetto

Gichuru

et al. 2019

Heart

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background Despite simpler regimens than vitamin K antagonists (VKas) for stroke prevention in atrial fibrillation (aF), adherence (taking drugs as prescribed) and persistence (continuation of drugs) to direct oral anticoagulants are suboptimal, yet understudied in electronic health records (ehrs). Objective We investigated (1) time trends at individual and system levels, and (2) the risk factors for and associations between adherence and persistence. Methods in UK primary care ehr (The health information network 2011-2016), we investigated adherence and persistence at 1 year for oral anticoagulants (Oacs) in adults with incident aF. Baseline characteristics were analysed by Oac and adherence/persistence status. risk factors for nonadherence and non-persistence were assessed using cox and logistic regression. Patterns of adherence and persistence were analysed. results among 36 652 individuals with incident aF, cardiovascular comorbidities (median cha 2 Ds 2 Vasc[congestive heart failure, hypertension, age≥75 years, Diabetes mellitus, stroke, Vascular disease, age 65-74 years, sex category] 3) and polypharmacy (median number of drugs 6) were common. adherence was 55.2% (95% ci 54.6 to 55.7), 51.2% (95% ci 50.6 to 51.8), 66.5% (95% ci 63.7 to 69.2), 63.1% (95% ci 61.8 to 64.4) and 64.7% (95% ci 63.2 to 66.1) for all Oacs, VKa, dabigatran, rivaroxaban and apixaban.One-year persistence was 65.9% (95% ci 65.4 to 66.5), 63.4% (95% ci 62.8 to 64.0), 61.4% (95% ci 58.3 to 64.2), 72.3% (95% ci 70.9 to 73.7) and 78.7% (95% ci 77.1 to 80.1) for all Oacs, VKa, dabigatran, rivaroxaban and apixaban. risk of non-adherence and non-persistence increased over time at individual and system levels. increasing comorbidity was associated with reduced risk of non-adherence and non-persistence across all Oacs. Overall rates of 'primary non-adherence' (stopping after first prescription), 'non-adherent nonpersistence' and 'persistent adherence' were 3.5%, 26.5% and 40.2%, differing across Oacs. Conclusions adherence and persistence to Oacs are low at 1 year with heterogeneity across drugs and over time at individual and system levels. Better understanding of contributory factors will inform interventions to improve adherence and persistence across Oacs in individuals and populations.on July 10, 2020 by guest. Protected by copyright.

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Section: Discussionsupporting

confidence: 93%

Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study

Banerjee

Benedetto

Gichuru

et al. 2019

Heart

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“…Polypharmacy was identified as a factor associated with non-adherence in the systematic review by Gellad et al [ 28 ]. In contrast to our results, polypharmacy, identified as a concurrent use of 5 or more drugs, represented a factor associated with a lower probability of non-adherence in the retrospective cohort study by Ofori-Asenso et al [ 29 ] which analyzed predictors of first-year non-adherence and discontinuation among older adults.…”

Section: Discussioncontrasting

confidence: 99%

Non-Adherence to Statin Treatment in Older Patients with Peripheral Arterial Disease Depending on Persistence Status

et al. 2020

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The effectiveness of statins in secondary prevention of peripheral arterial disease (PAD) largely depends on patients’ adherence to treatment. The aims of our study were: (a) to analyze non-adherence during the whole follow-up in persistent patients, and only during persistence for non-persistent patients; (b) to identify factors associated with non-adherence separately among persistent and non-persistent patients. A cohort of 8330 statin users aged ≥65 years, in whom PAD was newly diagnosed between January 2012–December 2012, included 5353 patients persistent with statin treatment, and 2977 subjects who became non-persistent during the 5-year follow-up. Non-adherence was defined using the proportion of days covered <80%. Patient- and statin-related characteristics associated with non-adherence were identified with binary logistic regression. A significantly higher proportion of non-adherent patients was found among non-persistent patients compared to persistent subjects (43.6% vs. 29.6%; p < 0.001). Associated with non-adherence in both persistent and non-persistent patients was high intensity statin treatment, while in non-persistent patients, it was employment and increasing number of medications. In patients with a poor adherence during their persistent period, an increased risk for discontinuation may be expected. However, there is also non-adherence among persistent patients. There are differences in factors associated with non-adherence depending on patients’ persistence.

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“…In a large US survey, the prevalent use was 29, 24, and 14% in the age ranges of 80–84, 85–89, and over 90 years, respectively [ 2 ]. On the other hand, older patients often have low adherence and are discontinuing statin treatment, especially in primary prevention [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Role of Statin Therapy in Primary Prevention of Cardiovascular Disease in Elderly Patients

Strandberg

2019

Curr Atheroscler Rep

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Purpose of Review Hypercholesterolemia and statin treatment are nowadays common among people older than 75 years, but clinical heterogeneity in this increasing age group is wide, and treatment decisions may differ from those in younger patients. Aim is to discuss the presentation, modifying factors, and treatment decisions of hypercholesterolemia (usually with statins) in older persons and focusing on primary prevention. Recent Findings There are no randomized controlled trials in persons older than 80 years at baseline. Randomized controlled trial findings in younger patients and 75+ subgroups and in observational studies support treatment in secondary prevention of atherosclerotic cardiovascular disease (ASCVD), but trial evidence in primary prevention is less clear. Available data do not imply specific harms in older patients, and, therefore, also, judicious primary prevention is possible. However, persons older than 75 years are biologically a very heterogeneous group with frequent frailty, comorbid conditions, and multiple concomitant drugs. All these, as well as personal preferences, must be taken into account in treatment decisions. Summary Statin treatment is only one way to prevent ASCVD in older people. Treatment of hypercholesterolemia should be started far before 75–80 years, and there is no need to discontinue statin treatment due to chronological age alone. After 75 years, treatment should be started in patients with ASCVD and judiciously in primary prevention. Like all prevention, statin treatment should be discontinued when palliative treatment is started. Ongoing and planned trials in 70+ individuals will give more information about primary prevention in older persons.

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Predictors of first‐year nonadherence and discontinuation of statins among older adults: a retrospective cohort study

Cited by 40 publications

References 47 publications

Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study

Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study

Non-Adherence to Statin Treatment in Older Patients with Peripheral Arterial Disease Depending on Persistence Status

Role of Statin Therapy in Primary Prevention of Cardiovascular Disease in Elderly Patients

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