Long-term adherence to low-dose aspirin therapy for cardiovascular prevention in routine clinical practice in United Kingdom and Germany

Abstract Background Low-dose aspirin is effective in the prevention of ischemic vascular events and studies have shown a preventative effect on colorectal cancer (CRC). However, adherence to therapy is likely an important factor for these benefits to be seen and non-adherence is associated with sub-optimal outcomes. Purpose To assess the long-term adherence to low-dose aspirin therapy in the primary and secondary cardiovascular (CVD) prevention population Methods This retrospective cohort study used data from United Kingdom (UK) – The Health Improvement Network Database and Germany (DE) – IQVIA Disease Analyzer and analyzed using an adaptation of Observational Health Data Sciences and Informatics (OHDSI) ATLAS Tool. Patients 18 years or older, with at least two prescriptions of low-dose aspirin (75–100mg) within the first year of index date during the study period between 2007 and 2018, and with at least 12 months of observation before and after the index date were included in the study. The patients with a CVD diagnosis or a CABG/PCI procedure before the index date or a prescription of dual antiplatelet at index date were classified as secondary CVD prevention. The remaining patients were classified as potential primary CVD prevention. The index date was first prescription of low-dose aspirin. Adherence was calculated using medication possession ratio (MPR) which is number of days of medication supplied within the refill interval divided by number of days in the refill interval. Long term adherence was divided in three categories namely patients with ≤2 years, 2-≤5 years, and 5-≤10 years of follow-up. Results The total number of patients receiving low-dose aspirin was 327,806 (183,089 in UK and 144,717 in DE with up to 10 years of follow-up). A total of 112,887 and 101,704 received low-dose aspirin for secondary CVD prevention; 70,202 and 43,013 potentially for primary CVD prevention in UK and DE, respectively. Median adherence to low-dose aspirin in UK and DE for patients with ≤2 years of follow-up was 88% and 80% for secondary CVD prevention, respectively; 84% and 74% for 2-≤5 years; and 75% and 59% for 5-≤10 years, respectively. Median adherence to low-dose aspirin in UK and DE for patients with ≤2 years was 76% and 75% for potential primary CVD prevention; 65% and 66% for 2-≤5 years; 49% and 49% for 5-≤10 years, respectively (Figure). Conclusion The long-term adherence to low dose aspirin was quite high with more than half the patients being adherent to their treatment. Overall, the adherence was higher in secondary compared to primary CVD prevention. The estimates for adherence might be underestimated due to potential over the counter use of low-dose aspirin. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bayer AG

Download Full-text

Long-term persistence to low-dose aspirin for cardiovascular prevention in routine clinical practice in United Kingdom and Germany

European Heart Journal ◽

10.1093/ehjci/ehaa946.1438 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Vora ◽

M Soriano-Gabarro ◽

B Russell ◽

H Morgan Stewart

Keyword(s):

Index Date ◽

Low Dose ◽

Aspirin Therapy ◽

Routine Clinical Practice ◽

Vascular Events ◽

Dose Aspirin ◽

Low Dose Aspirin ◽

Cvd Prevention

Abstract Background Low-dose aspirin is effective in the prevention of ischemic vascular events and studies have shown a preventative effect on colorectal cancer (CRC). Discontinuation of low-dose aspirin is associated with increased risk of ischaemic vascular events. However, data on long-term persistence to low-dose aspirin from routine clinical practice are limited. Purpose To assess the long-term persistence to low-dose aspirin therapy in the primary and secondary cardiovascular (CVD) prevention population Methods This retrospective cohort study used data from United Kingdom (UK) – The Health Improvement Network database and Germany (DE) – IQVIA Disease Analyzer and analyzed using an adaptation of Observational Health Data Sciences and Informatics (OHDSI) ATLAS Tool. Patients 18 years or older, with at least two prescriptions of low-dose aspirin (75–100mg) within the first year of index date during the study period between 2007 and 2018, and with at least 12 months of observation before and after the index date were included in the study. The patients with a CVD diagnosis or a CABG/PCI procedure before the index date or a prescription of dual antiplatelet at index date were classified as secondary CVD prevention. The remaining patients were classified as potential primary CVD prevention. The index date was first prescription of low-dose aspirin. Persistence was calculated if the gap between two prescriptions exceeds 60 days. Patients with such gaps still receiving prescription after 60 days were plotted based on the number of gaps identified during the follow-up and if no prescription was recorded then they were considered discontinued. Results The total number of patients receiving low-dose aspirin was 327,806 (183,089 in UK and 144,717 in DE with up to 10 years of follow-up). A total of 112,887 and 101,704 received low-dose aspirin for secondary CVD prevention; 70,202 and 43,013 potentially for primary CVD prevention in UK and DE, respectively. Persistence at two years with a few gaps was 67% and 59% in UK and DE for secondary CVD prevention; 57% and 53% for primary CVD prevention, respectively. With multiple Gaps, 50% and 36% still receive prescription low-dose aspirin for 10 years in UK and DE, respectively for secondary CVD prevention. For Primary prevention, 36% and 32% receive prescription of aspirin for 10 years with multiple gaps in UK and DE (Figure). Conclusion After the initial drop in persistence the patients tend to continue their low-dose aspirin treatment for long-term, although with multiple gaps. Overall, the persistence was higher in secondary compared to primary CVD prevention. Improving persistence to low-dose aspirin therapy in the initial years may help in continuity of their treatment over long-term. Persistence might be underestimated due to potential over the counter use of low-dose aspirin. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bayer AG

Download Full-text

The importance of validating intracranial bleeding diagnoses in The Health Improvement Network, United Kingdom: Misclassification of onset and its impact on the risk associated with low‐dose aspirin therapy

Pharmacoepidemiology and Drug Safety ◽

10.1002/pds.4561 ◽

2018 ◽

Vol 28 (2) ◽

pp. 134-139 ◽

Cited By ~ 3

Author(s):

Lucía Cea Soriano ◽

David Gaist ◽

Montse Soriano‐Gabarró ◽

Luis A. García Rodríguez

Keyword(s):

United Kingdom ◽

Low Dose ◽

Aspirin Therapy ◽

Intracranial Bleeding ◽

Health Improvement ◽

Dose Aspirin ◽

Low Dose Aspirin ◽

The Health Improvement Network

Download Full-text

Role of Helicobacter pylori infection in gastroduodenal injury and gastric prostaglandin synthesis during long term/low dose aspirin therapy: a prospective placebo-controlled, double-blind randomized trial

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.2001.03928.x ◽

2001 ◽

Vol 96 (6) ◽

pp. 1751-1757 ◽

Cited By ~ 38

Author(s):

Mark Feldman ◽

Byron Cryer ◽

Damien Mallat ◽

Mae F. Go

Keyword(s):

Helicobacter Pylori ◽

Randomized Trial ◽

Low Dose ◽

Aspirin Therapy ◽

Prostaglandin Synthesis ◽

Double Blind ◽

Dose Aspirin ◽

Low Dose Aspirin

Download Full-text

Micro-simulation model to predict effects of low-dose aspirin on colorectal cancer, cardiovascular disease and safety outcomes among low-dose aspirin users

European Heart Journal ◽

10.1093/ehjci/ehaa946.3452 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Bollaerts ◽

J Biccler ◽

V Pareen ◽

E Sole ◽

L.A Garcia Rodriguez ◽

...

Keyword(s):

Colorectal Cancer ◽

Cardiovascular Disease ◽

Simulation Model ◽

Low Dose ◽

Funding Source ◽

Peptic Ulcers ◽

Gi Bleeding ◽

Dose Aspirin ◽

Low Dose Aspirin ◽

Cvd Prevention

Abstract Background Regular use of low-dose aspirin (LDA) has been shown to reduce the risk of cardiovascular disease (CVD). Recent evidence indicates that regular LDA use also reduces the risk of colorectal cancer (CRC). Use of LDA has also been associated with an increased risk of gastrointestinal (GI) bleeding, peptic ulcers and intracranial hemorrhage (ICH). Purpose We aim to evaluate the population-level benefits and risks of daily and/or regular LDA among individuals taking LDA for primary or secondary CVD prevention in the United Kingdom (UK) accounting for the evidence on the reduced CRC risk. Methods Individual-level state transition modelling was used to predict the impact of LDA on CRC, CVD, safety events (GI bleeding, ICH and symptomatic peptic ulcers) and related deaths in a UK population. Individual event histories were simulated for hypothetical cohorts of 1 million adults aged 50–59 years and aged 60–69 years indicated to take LDA for primary or secondary CVD prevention. The QRISK CVD prediction score was used to simulate adults indicated to use LDA for CVD prevention. Model parameters were informed based on published scientific literature on CVD, CRC and safety outcomes mimicking the UK epidemiology and prevention guidelines. Monte Carlo simulation was used to account for parameter uncertainty. Results In the cohort of subjects for which low-dose aspirin use was initiated between 50–59 years, the decrease in incidence rates (IRs) (per 100,000person years) of non-fatal CVD was smaller when low-dose aspirin use was initiated for primary prevention compared to initiation for secondary prevention (−203 [95% UI, −277 to −115] versus −794 [95% UI, −997 to −536]). Similar results were obtained for fatal CVD (−97 [95% UI, −136 to −60] versus −381 [95% UI, −502 to −257]). Whether low-dose aspirin treatment was initiated for primary or secondary CVD prevention did not greatly influence the changes in the IR of the non-CVD outcomes. The changes in IR for fatal CRC were −46 [−69, −31] and −44 [−67, −26] for primary and secondary CVD prevention while the changes in IR for fatal bleeding were 5 [1, 9] and 5 [1, 10]. Similar results were obtained when low-dose aspirin use was initiated between 60–69 years. Conclusions In all simulation settings considered, low-dose aspirin related reductions in non-fatal and fatal CVD outcomes were larger in case of secondary CVD prevention compared to primary CVD prevention. These reductions were larger than the increases in fatal safety events. This favorable benefit-risk profile is more pronounced in the case of secondary CVD prevention. The results from the simulation model can be used to inform discussions with patients about the potential benefits and risk of LDA initiation. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bayer AG

Download Full-text

Trajectories of Adherence to Low-Dose Aspirin Treatment Among the French Population

Journal of Cardiovascular Pharmacology and Therapeutics ◽

10.1177/1074248419865287 ◽

2019 ◽

Vol 25 (1) ◽

pp. 37-46 ◽

Cited By ~ 1

Author(s):

Aya Ajrouche ◽

Candice Estellat ◽

Yann De Rycke ◽

Florence Tubach

Keyword(s):

Low Socioeconomic Status ◽

Index Date ◽

Low Dose ◽

French Population ◽

Low Socioeconomic ◽

National Health Care ◽

Dose Aspirin ◽

Low Dose Aspirin ◽

Health Care Database

Background: Previous studies have shown that adherence to low-dose aspirin (LDA) is suboptimal. However, these studies were based on an average measure of adherence during follow-up, ignoring its dynamic process over time. We described the trajectories of adherence to LDA treatment among the French population over 3 years of follow-up. Methods: We identified a cohort of 11 793 new LDA users, aged ≥50 years in 2010, by using the French national health-care database. Patients included had at least 3 years of history in the database before study entry to exclude prevalent aspirin users and to assess baseline comorbidities. They were followed from the first date of LDA supply (the index date) until the first date among death, exit from the database, or 3 years after the index date. Adherence to LDA was assessed every 3 months by using the proportion of days covered (PDC) and dichotomized with a cutoff of PDC of 0.8. We used group-based trajectory modeling to identify trajectories of LDA adherence. Predictors of LDA adherence trajectory membership were identified by multinomial logistics regression. Results: We identified 4 trajectories of adherence among new LDA users: the not-adherents (4737 [40.2%]), the delayed not-adherents (gradual decrease in adherence probability, 1601 [13.6%]), the delayed adherents (gradual increase in adherence probability, 1137 [9.6%]), and the persistent adherents (4318 [36.6%]). The probability of belonging to the not-adherent group was increased with female sex, low socioeconomic status, and polymedication and was reduced with a secondary indication for LDA use, such as diabetes, hypertension, and dementia, at least 4 consultations in the previous year, or 1 hospitalization or a cardiologist consultation in the 3 months before the index date. Conclusion: This study provides a dynamic picture of adherence behaviors among new LDA users and underlines the presence of critical trajectories that intervention could target to improve adherence.

Download Full-text