More than half of heart patients nonadherent to multi-drug regimens

Over half of heart patients on a triple-drug regimen of ACE inhibitors, statins and either calcium channel blockers (CCBs) or aspirin are nonadherent to their medications, researchers reported in the American Journal of Cardiology Feb. 6.

The global burden of CVD remains heavy in 2020, first author Niccolò Lombardi, PharmD, PhD, and colleagues wrote in AJC, and it’s only increasing as the world’s population lives longer. Some 60% of older adults suffer from at least two chronic diseases—the majority of which are cardiovascular conditions—forcing them to take a daily cocktail of drugs to keep multiple illnesses at bay.

Polypharmacy is effective, the authors said, but it also complicates a person’s medication regimen, making them less likely to stick to their doctor’s treatment plan. Data from the World Health Organization suggest nonadherence to antihypertensive meds in particular is low, ranging from 30% to 50%.

“One of the biggest lacks of clarity on multiple pill use for CVD prevention is associated [with] poor knowledge of demographic and clinical determinants related to nonadherence,” Lombardi, of the University of Florence in Florence, Italy, and co-authors wrote. “Given this background, this study was conducted to assess adherence levels in patients treated with triple free drug combinations.”

The drugs in question included ACE inhibitors, CCBs, low-dose aspirin and statins, and Lombardi et al. studied their concurrent use in a cohort of patients from the Health Search Database. The authors considered patients prescribed to one of two regimens—either an ACE inhibitor, CCB and statin or an ACE inhibitor, statin and low-dose aspirin. Nonadherent patients were considered those who, at 1-year follow-up, were found to have a proportion of days covered of less than 80%.

The team found that 52.1% of patients were nonadherent to the ACE inhibitor/CCB/statin regimen, and 50.6% reported nonadherence to the ACE inhibitor/statin/aspirin regimen. Men and patients at a higher CV risk were more likely to be adherent to their pills; those with depression and atrial fibrillation were less likely to adhere.

“These results confirm that nonadherence is one of the most important hurdles to achieve effectiveness in preventing CVD,” the authors said.

Lombardi and colleagues said their findings may support general practitioners in an effort to identify at-risk patients earlier, since the study shed light on specific demographic and clinical characteristics linked to nonadherence. They said their work might pave the way for the development of improved clinical decision support systems (CDSS) to flag patients at risk for nonadherence during their first year of therapy.

“This approach should be easily implemented in primary care given the current and broad availability of electronic medical care charts, which are mandatory for GPs to provide patients,” the team wrote. “Through CDSS, GPs could choose the best strategy aimed to minimize the burden of nonadherence. They comprise the use of education materials on the relevance of medication adherence, the advice of the use of supporting tools, a greater interaction with pharmacists and nurses, as well as the simplification of drug regimens through the use of fixed combination pills, whenever patients are on target with free combinations.”

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