The Era of Polypills in the Management of Cardiovascular Diseases: Are We There Yet?

Khan, Arsalan Aamir; Siddiqui, Sarush Ahmed; Yasmin, Farah; Abidi, Syeda Mahnoor; Tariq, Rabbia; Ahmed, Hiba; Murtaza, Noor; Jawed, Fareeha; Lashkerwala, Sehan Siraj; Moin, Ariba; Shah, Syed Muhammad Ismail; Ullah, Irfan; Yousaf, Zohaib; Faizan, Muhammad; Shahid, Muhammad Huzaifa

doi:10.1016/j.cpcardiol.2022.101233

Cited by 7 publications

(4 citation statements)

References 77 publications

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“…Our findings are also in line with evidence on the Polypill ( Webster et al. , 2017 ; 2020 ; Khan et al. , 2023 ) and other innovations ( Abimbola and Keelan et al.…”

Section: Discussionsupporting

confidence: 92%

Adoption and scale-up of the cardiovascular Polypill: a realist institutional analysis

Abimbola

Liu

2022

Health Policy and Planning

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Efforts to promote the adoption and scale up of health system innovations must contend with existing institutional context. But there are no commonly used frameworks to ensure that the insights of actors involved in such institutional efforts connect to one another. To test and modify a potential framework – the ‘four-by-four’ framework – we interviewed researcher-entrepreneurs involved in the unfolding story of the cardiovascular Polypill. The framework has four types/level of institution that affect adoption and scale up – 1) informal institutions (L1 – e.g., social norms), 2) formal institutions (L2 – e.g., government policies and regulation), 3) organisational structures (L3 – e.g., organisational boards and mission), and 4) everyday exchange (L4 – e.g., service delivery); vis-à-vis four potential entrepreneurial strategies in response – 1) abide by existing institutions, 2) evade them, 3) alter them, and/or 4) exit entrepreneurial action. Using this framework, we conducted a realist-informed analysis to understand how context (i.e., institutions) and mechanism (i.e., entrepreneurial strategies) influence each other to shape outcomes (i.e., adoption and scale up). We found that researcher-entrepreneurs began with efforts to abide with existing institutions but encountered institutional obstacles at each level. Efforts to abide were followed by seeking to evade and/or alter unfavourable institutions, with greater success evading and/or altering lower (L3 and L4) than upper (L1 and L2) institutions. Exit considerations followed the failure of evade or alter. Shifts between strategies was propelled by learning. The ‘four-by-four’ framework can be used as a scaffold to generate narratives of adoption or scale up efforts, a sensitising tool to prospectively map out contingencies, and a matrix to synthesise narratives and experiences across multiple innovations or settings. Used in these ways, the ‘four-by-four’ framework can help to optimise the transferability and cumulation of insights on how to promote the adoption and scale up of health system innovations.

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“…Our findings are also in line with evidence on the Polypill ( Webster et al. , 2017 ; 2020 ; Khan et al. , 2023 ) and other innovations ( Abimbola and Keelan et al.…”

Section: Discussionsupporting

confidence: 92%

Adoption and scale-up of the cardiovascular Polypill: a realist institutional analysis

Abimbola

Liu

2022

Health Policy and Planning

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“…При его повышении больным с [49], полипилл определялся как препарат, содержащий 6 компонентов лекарственной терапии ССЗ, непосредственно влияющих на ФР развития ССЗ: уровень общего холестерина (ОХ), холестерина липопротеинов низкой плотности (ХС-ЛПНП), АД, агрегацию тромбоцитов и содержал в своем составе статин, три АГП разных классов в половине стандартной дозировки (ТД, ББ и ИАПФ), фолиевую кислоту и ацетилсалициловую кислоту (аспирин). В настоящее время существует много вариантов полипилл [50], включающих в свой состав различные комбинации лекарственных средств. В его состав могут входить: ацетилсалициловая кислота в дозе от 75 до 100 мг, ИАПФ или блокатор рецепторов ангиотензина (БРА), статин, диуретик и/ или ББ, и/или БКК.…”

Section: концепция полипиллunclassified

Russian medical society expert consensus on arterial hypertension: use of fixed combinations in the treatment of patients with arterial hypertension

Kisliak,

Zhernakova,

Aksenova

et al. 2024

jour

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Despite the large arsenal of antihypertensive agents, BP control, both in Europe and in Russia, remains at a low level, more than 50% patients do not reach the goal BP levels. At the same time, data from the results of RCTs demonstrate that the achievement of goal BP values is possible in most patients, no more than 5-10% of patients have resistance to antihypertensive therapy. Sufficient evidence has been accumulated that low adherence to treatment remains afundamental contributing factor to insufficient BP control. There is evidence that adherence to treatment closely correlates with the complex dosing regimen of the drugs and the number of tablets taken. Low adherence has been shown to be associated with an increased risk of cardiovascular complications. Furthermore, evidence suggests that medical inertia contributes to treatment failure in patients remaining on monotherapy or receiving inadequate suboptimal therapy. The use of combination therapy, including the use of fixed combinations in most patients, can help to solve both problems. This consensus focuses on various issues related to the prescription of combination therapy in the form of fixed combinations and polypill.

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“…The CVPs have practically remained underutilized in clinical settings across the globe. This has been attributed to different issues including the physician’s personal perspectives on CVPs due to lack of established evidence base, their practical inexperience in using combination therapies and inability to titrate individual drug in order to achieve desired therapeutic outcome, some patient factors and barriers to health system ( Webster et al, 2020 ; Patel et al, 2022 ; Gnanenthiran et al, 2023 ; Khan et al, 2023 ).…”

Section: Issues To Be Addressed Before Implementing the Polypillmentioning

confidence: 99%

Redefining the polypill: pros and cons in cardiovascular precision medicine

Birla,

Angural,

Madathumchalil

et al. 2023

Front. Pharmacol.

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Polypill is a multi-drug formulation in a single pill intended to simplify the drug regimen and reduce medication-induced adverse effects. The most common multidrug combinations in a polypill are used to treat cardiovascular diseases and are targeted against key modifiable risk factors such as hypertension and hyperlipidemia. These contain blood-pressure lowering agents, statins, and anti-platelet agents usually in a fixed dose. Polypills can be an affordable therapeutic intervention for treating high-risk patients, as these are proven to increase patients’ adherence to medication and improve clinical outcomes. Over the previous years, randomized clinical trials of several polypills have yielded contradictory findings, raising skepticism regarding their widespread use in primary disease prevention. Here, we have reviewed the concept of polypills, the evidence-based strengths, the limitations of this polypharmacy intervention strategy, and discussed future directions for their use in the primary and secondary preventive management of cardiovascular diseases and associated risk factors.

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The Era of Polypills in the Management of Cardiovascular Diseases: Are We There Yet?

Cited by 7 publications

References 77 publications

Adoption and scale-up of the cardiovascular Polypill: a realist institutional analysis

Adoption and scale-up of the cardiovascular Polypill: a realist institutional analysis

Russian medical society expert consensus on arterial hypertension: use of fixed combinations in the treatment of patients with arterial hypertension

Redefining the polypill: pros and cons in cardiovascular precision medicine

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