Statin Intolerance and Risk of Coronary Heart Events and All-Cause Mortality Following Myocardial Infarction

Şerban, Corina; Colantonio, Lisandro D.; Manthripragada, Angelika D.; Monda, Keri L.; Bittner, Vera; Banach, Maciej; Chen, Ligong; Huang, Lei; Dent, Ricardo; Kent, Shia T.; Muntner, Paul; Rosenson, Robert S.

doi:10.1016/j.jacc.2016.12.036

Cited by 275 publications

(171 citation statements)

References 32 publications

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“…Whereas it is well known that statin non-adherence is associated with worse outcomes, a recent retrospective analysis also suggests that statin intolerance is similarly associated with increased risk of recurrent MI [64]. Fortunately, not only are therapeutic alternatives now available, but among patients who discontinue therapy, there is recent evidence that lowering the dose or changing to a different agent is associated with reinitiation of therapy [65].…”

Section: Therapy-related Factorsmentioning

confidence: 99%

Recent Approaches to Improve Medication Adherence in Patients with Coronary Heart Disease: Progress Towards a Learning Healthcare System

Levy¹,

Huang

et al. 2018

Curr Atheroscler Rep

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Purpose of Review Non-adherence to medications for the secondary prevention of myocardial infarction (MI) is a major contributor to morbidity and mortality in these patients. This review describes recent advances in promoting adherence to therapies for coronary artery disease (CAD). Recent Findings Two large randomized controlled trials to “incentivize” adherence were somewhat disappointing; neither financial incentives nor “peer pressure” successfully increased rates of adherence in the post-MI population. Patient education and provider engagement appear to be critical aspects of improving adherence to CAD therapies, where the provider is a physician, pharmacist, or nurse and follow-up is performed in person or by telephone. Fixed-dose combinations of CAD medications, formulated as a so-called “polypill,” have shown some early efficacy in increasing adherence. Technological advances that automate monitoring and/or encouragement of adherence are promising but seem universally dependent on patient engagement. For example, medication reminders via text message perform better if patients are required to respond. Multifaceted interventions, in which these and other interventions are combined together, appear to be most effective. Summary There are several available types of proven interventions through which providers, and the health system at large, can advance patient adherence to CAD therapies. No single intervention to promote adherence will be successful in all patients. Further study of multifaceted interventions and the interactions between different interventions will be important to advancing the field. The goal is a learning healthcare system in which a network of interventions responds and adapts to patients’ needs over time.

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Section: Therapy-related Factorsmentioning

confidence: 99%

Recent Approaches to Improve Medication Adherence in Patients with Coronary Heart Disease: Progress Towards a Learning Healthcare System

Levy¹,

Huang

et al. 2018

Curr Atheroscler Rep

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“…Patient demographics and clinical characteristics (e.g., ASCVD status, statin intolerance as defined previously 14 , and prescriber specialty) between patients with approved and rejected claims were assessed for significant differences using chi-square or t-tests as appropriate, using a significance level of α = 0.05. Comparisons were also stratified by ASCVD diagnosis (primary or secondary prevention).…”

Section: Methodsmentioning

confidence: 99%

Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Therapy

et al. 2017

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Background PCSK9 inhibitors (PCSK9i) are a novel class of medications for patients with familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease (ASCVD) requiring additional lipid lowering beyond dietary measures and statin use. Because of the drugs' high cost, rates of prescription approval by payers may be low. We aimed to identify payer approval and rejection rates for PCSK9i prescriptions, and potential factors influencing these rates. Methods This is a retrospective, descriptive cohort study utilizing nationwide pharmacy claims linked to electronic medical records from a nationwide data warehouse. The dataset includes over 220 million patients from all fifty states and all payer types with 5,140 distinct health plans. PCSK9i prescriptions were submitted for 51,422 patients in the pharmacy dataset. The main outcome was approval or rejection of PCSK9i prescription claims. Factors associated with approval and rejection of these medications in the US were assessed. Results Among patients who were prescribed a PCSK9i, 47.0% were approved for coverage by the payer. Variables that were associated with PCSK9i approval included age >65 years (p<0.01), history of ASCVD (p<0.01) prescription by a cardiologist or non-primary care provider (p<0.01), statin intolerance (p=0.03), longer statin duration (p=0.01), and non-commercial payers (p<0.01). Higher low density lipoprotein cholesterol (LDL-C) levels were not associated with higher approval rates. Commercial third-party payers had the lowest approval rates (24.4%) and Medicare had the highest (60.9%). Conclusions Rates of approval for PCSK9i therapy are low, even for patients who appear to meet labeled indications. While a combination of clinical characteristics increases the likelihood of approval, payer type is the most significant factor.

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“…ПЕРЕДОВАЯ СТАТЬЯ ОБЗОР ЛИТЕРАТУРЫ торное отношение рисков (ОР) повторного ИМ было ОР =1,5 (95% ДИ 1,3;1,73) у принимавших регулярно в сравнении с отказавшимися по той или иной при-чине; ОР для других сердечно-сосудистых событий также было 1,51 (95% ДИ 1,31;1,7); для смерти от всех причин ОР =0,96 (95% ДИ 0,87;1,06) [11]. В другом крупном исследовании, регистре Италии, Maggioni, et al (2017), включившем данные почти 3 млн.…”

Section: врач -лечит а больной -лечится? современные представления оunclassified

Clinician — Treats, and Patient — Being Treated? Recent View on the Treatment Adherence in Coronary Heart Disease Setting

Шайдюк¹,

Кудинова²,

Таратухин³

et al. 2017

Russ J Cardiol

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Медицинская наука создала широкий спектр инструментов для предотвращения и лечения заболе-ваний. Многие из таких инструментов требуют актив-ного участия самого пациента, что предполагает регу-лярное следование рекомендациям, регулярный приём препаратов. Это получило название привер-женности к лечению. В англоязычной литературе ему соответствует два термина: compliance и adherence. Они имеют разное значение: compliance предполагает строгое следование предписаниям -"делать как ска-зано", тогда как adherence подразумевает реализацию предписания с учётом внешних (социальные условия, среда) и внутренних (характер, психологические состояния, убеждения) факторов. В отличие от "ком-плаентного" индивида, "адгерентный" может добав-лять элемент "творчества" к рекомендациям. Он может модифицировать предписания, следовать больше чем назначено или меньше. О комплайнсе, следовательно, нужно говорить в отношении приёма препаратов, тогда как немедикаментозное лечение предпочтительно определять через "адгерентность" [1]. Выделено также понятие "конкордантность" (concordance). Она определяется как согласованная между пациентом и врачом позиция относительно режима лечения, результатов и соответствующего поведения; отношения в большей степени совмест-ные, чем определяемые комплайнсом [2]. Pardaens S, et al. (2017) изучали причины выхода пациентов из программ кардиореабилитации после ОКС, кардиохирургического вмешательства и при сердечной недостаточности. В исследование вошло 489 пациентов. Факторами, связанными с прежде-временным выходом из программы реабилитации (то есть, пропуск более половины занятий; таковых было 20%, n=96), оказались анамнез инсульта (отношение шансов, ОШ =4,18), наличие хронической обструк- Обзор литературы включает данные современных исследований привержен-ности к терапии и немедикаментозному лечению преимущественно у больных ишемической болезнью сердца. Рассматриваются различные способы повы-шения приверженности, приводятся психологические модели "информация-мотивация-стратегия", "транстеоретическая модель". Рассматривается феномен "политаблетки". Приводятся различия между тремя вариантами приверженности к лечению (compliance, adherence, concordance) в зависимо-сти от активности участия самого пациента. The literary review includes data from recent research on the medication and nonmedication treatment adherence of coronary heart disease patients. The various approaches considered, of the adherence improvement, and psychological models presented, the "information-motivation-strategy" and "transtheoretical model". The polypill phenomenon is considered. Also three terms on adherence are commented: compliance, concordance and adherence itself, depending on the part of patient's active role. ВРАЧ -ЛЕЧИТ, А БОЛЬНОЙ -ЛЕЧИТСЯ? СОВРЕМЕННЫЕ ПРЕДСТАВЛЕНИЯ О ПРИВЕРЖЕННОСТИ К ТЕРАПИИ ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА Российский кардиологический журнал Russ

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Statin Intolerance and Risk of Coronary Heart Events and All-Cause Mortality Following Myocardial Infarction

Cited by 275 publications

References 32 publications

Recent Approaches to Improve Medication Adherence in Patients with Coronary Heart Disease: Progress Towards a Learning Healthcare System

Recent Approaches to Improve Medication Adherence in Patients with Coronary Heart Disease: Progress Towards a Learning Healthcare System

Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Therapy

Clinician — Treats, and Patient — Being Treated? Recent View on the Treatment Adherence in Coronary Heart Disease Setting

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