Medication adherence in patients with stable coronary artery disease in primary care

Introduction: Lack of research targeting non-adherence to cardiovascular medications in Russia prevents from developing effective interventions to improve adherence. The aim was to study medication adherence in patients with stable coronary artery disease in primary care. Material and methods: The study was conducted in a primary care setting of Moscow. Demography, medical history, pharmacotherapy data were obtained retrospectively from 386 coronary patients’ medical records. Medication adherence was measured by 8-item Morisky Medication Adherence Scale (MMAS-8). A statistical analysis was performed using SPSS Statistics V16.0. Results and discussion: According to the results from MMAS-8, 188 (48.7%) coronary patients had high medication adherence, 135 (35.0%) – moderate, and 63 (16.3%) – low. By the dichotomous interpretation: 48.7% (n = 188) – were adherent, 51.3% (n = 198) – were non-adherent. These groups were similar in gender distribution, age, and medical history profile (p > 0.1 for all variables). Smokers prevailed in the non-adherent group (13.6 vs. 5.3%; p = 0.009). Both groups were equally prescribed beta-blockers, antiplatelets, and statins (p > 0.1 for all). Use of fixed dose combinations (11.7 vs. 5.6%; p = 0.048) and the number of pills taken (mean 5.64 ± 1.52 vs. 5.99 ± 1.62; p = 0.029) were associated with better adherence. Higher values of total cholesterol (mean 5.2 ± 1.4 vs. 4.7 ± 1.2 mmol/L; p < 0.001) and low-density lipoprotein cholesterol (mean 2.9 ± 1.2 vs. 2.4 ± 0.9 mmol/L; p < 0.001) were revealed in non-adherents. Subjects with suboptimal adherence visited general practitioners more frequently (median 5 vs. 3 visits; p = 0,003). Conclusion: Medication non-adherence in coronary outpatients exceeded 50%. High adherence was associated with more frequent use of fixed dose combinations and fewer pills taken by patient. Smoking and poorer control of blood lipids prevailed in non-adherents, who also caused higher load on general practitioners.

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Critical aspects of the management of stable coronary artery disease in primary care practice or how to increase the efficacy of evidence-based pharmacological therapy?

Research Results in Pharmacology ◽

10.3897/rrpharmacology.6.53615 ◽

2020 ◽

Vol 6 (3) ◽

pp. 15-20

Author(s):

Sergey K. Zyryanov ◽

Sergey B. Fitilev ◽

Alexander V. Vozzhaev ◽

Irina I. Shkrebniova ◽

Dmitry A. Klyuev

Keyword(s):

Primary Care ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Medication Adherence ◽

Stable Coronary Artery Disease ◽

Density Lipoprotein ◽

Pharmacological Therapy ◽

Care Practice ◽

Cross Sectional ◽

Artery Disease

Introduction: The publication describes a fragment of the pharmacoepidemiologic study conducted to review the quality of management of patients with stable coronary artery disease (SCAD) in primary care over a 12-year period. The aim of the study was to justify the application of standard operating procedures (SOPs). Such determinants of pharmacotherapy as non-pharmacological modification of cardiovascular risk factors (RFs) and medication adherence were analyzed. Material and methods: A retrospective, cross-sectional, 3-stage (2006, 2011, 2018) study was conducted in a primary care setting of Moscow. As many as 3027, 1834, 805 patients with verified diagnosis of SCAD were included. Demographics, medical history, data on modifiable RFs and prescribed drug therapies were collected. At the third stage, medication adherence was measured, using the 8-item Morisky scale. Results and discussion: Over a 7-year period, better control of modifiable RFs in coronary patients was revealed. The target levels of blood pressure were reached in 58.3% (+20.7%; p < 0.05) of the patients, total cholesterol – in 33.0% (+16.0%; p < 0.05), and low-density lipoprotein cholesterol – in 23.3% (+12.2%; p < 0.05). Two critical problems that determined still inadequate RFs control were identified. The attention of physicians to RFs and rates of non-pharmacological interventions remained low throughout the study. Information on lifestyle RFs was recorded in fewer than one-third of the subjects. The lipid profile was registered only in half of patients’ histories. Non-adherence to pharmacotherapy was identified in 51.3% of patients. Conclusion: Further increase in efficacy of pharmacotherapy might be provided by application of SOPs regarding the registration and correction of modifiable cardiovascular RFs, identification of non-adherent patients and promotion of medication adherence.

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Fixed-dose combination of ivabradine and metoprolol in a patient with stable coronary artery disease: a case report

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4657 ◽

2021 ◽

Vol 26 (9) ◽

pp. 4657

Author(s):

A. M. Shimkevich

Keyword(s):

Coronary Artery Disease ◽

Case Report ◽

Clinical Practice ◽

Coronary Artery ◽

Stable Coronary Artery Disease ◽

Fixed Dose Combination ◽

Fixed Dose ◽

Actual Clinical Practice ◽

Dose Combination ◽

Artery Disease

This article discusses a case of using fixed-dose combination of ivabradine/metoprolol in actual clinical practice.

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Short-Term Cardioprotective Effects of the Original Perindopril/Amlodipine Fixed-Dose Combination in Patients with Stable Coronary Artery Disease: Results of the PAPA-CAD Study

Advances in Therapy ◽

10.1007/s12325-016-0392-8 ◽

2016 ◽

Vol 33 (10) ◽

pp. 1771-1781 ◽

Cited By ~ 4

Author(s):

Tamás Forster ◽

Csaba András Dézsi

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Stable Coronary Artery Disease ◽

Fixed Dose Combination ◽

Fixed Dose ◽

Short Term ◽

Dose Combination ◽

Cardioprotective Effects ◽

Artery Disease

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127 CHARACTERISTICS AND TREATMENT OF 2346 PATIENTS WITH STABLE CORONARY ARTERY DISEASE IN UK PRIMARY CARE

Heart ◽

10.1136/heartjnl-2013-304019.127 ◽

2013 ◽

Vol 99 (suppl 2) ◽

pp. A75.2-A76

Author(s):

P R Kalra ◽

D Zachariah ◽

N Greenlaw ◽

I Ford ◽

K Fox

Keyword(s):

Primary Care ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Stable Coronary Artery Disease ◽

Artery Disease

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80 Two Year Prognosis in Stable Coronary Artery Disease: A Prospective Study of 2346 Patients in UK Primary Care

Heart ◽

10.1136/heartjnl-2016-309890.80 ◽

2016 ◽

Vol 102 (Suppl 6) ◽

pp. A58.1-A58

Author(s):

Michael Pope ◽

Nicola Greenlaw ◽

Ian Ford ◽

Gabriel Steg ◽

Kim Fox ◽

...

Keyword(s):

Primary Care ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Prospective Study ◽

Stable Coronary Artery Disease ◽

Artery Disease ◽

A Prospective Study

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Antiplatelet Efficacy of Fixed-Dose Aspirin–Clopidogrel Combination in Patients with Stable Coronary Artery Disease Treated with Drug-Eluting Stent Implantation

Clinical Drug Investigation ◽

10.1007/s40261-015-0350-2 ◽

2015 ◽

Vol 35 (12) ◽

pp. 833-842 ◽

Cited By ~ 1

Author(s):

Sungmin Lim ◽

Pum Joon Kim ◽

Chunyeong Baek ◽

Tae-Hoon Kim ◽

Yoon Seok Koh ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Stent Implantation ◽

Stable Coronary Artery Disease ◽

Fixed Dose ◽

Drug Eluting Stent ◽

Dose Aspirin ◽

Drug Eluting ◽

Artery Disease

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The Effect of a WeChat-Based Tertiary A-Level Hospital Intervention on Medication Adherence and Risk Factor Control in Patients With Stable Coronary Artery Disease: Multicenter Prospective Study (Preprint)

10.2196/preprints.32548 ◽

2021 ◽

Author(s):

Boqun Shi ◽

Xi Liu ◽

Qiuting Dong ◽

Yuxiu Yang ◽

Zhongxing Cai ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Medication Adherence ◽

Stable Coronary Artery Disease ◽

Intervention Group ◽

Control Group ◽

Artery Disease ◽

Multicenter Prospective Study ◽

Level Hospital

BACKGROUND In China, ischemic heart disease is the main cause of mortality. Having cardiac rehabilitation and a secondary prevention program in place is a class IA recommendation for individuals with coronary artery disease. WeChat-based interventions seem to be feasible and efficient for the follow-up and management of chronic diseases. OBJECTIVE This study aims to evaluate the effectiveness of a tertiary A-level hospital, WeChat-based telemedicine intervention in comparison with conventional community hospital follow-up on medication adherence and risk factor control in individuals with stable coronary artery disease. METHODS In this multicenter prospective study, 1424 patients with stable coronary artery disease in Beijing, China, were consecutively enrolled between September 2018 and September 2019 from the Fuwai Hospital and 4 community hospitals. At 1-, 3-, 6-, and 12-month follow-up, participants received healthy lifestyle recommendations and medication advice. Subsequently, the control group attended an offline outpatient clinic at 4 separate community hospitals. The intervention group had follow-up visits through WeChat-based telemedicine management. The main end point was medication adherence, which was defined as participant compliance in taking all 4 cardioprotective medications that would improve the patient’s outcome (therapies included antiplatelet therapy, β-blockers, statins, and angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers). Multivariable generalized estimating equations were used to compare the primary and secondary outcomes between the 2 groups and to calculate the relative risk (RR) at 12 months. Propensity score matching and inverse probability of treatment weighting were performed as sensitivity analyses, and propensity scores were calculated using a multivariable logistic regression model. RESULTS At 1 year, 88% (565/642) of patients in the intervention group and 91.8% (518/564) of patients in the control group had successful follow-up data. We matched 257 pairs of patients between the intervention and control groups. There was no obvious advantage in medication adherence with the 4 cardioprotective drugs in the intervention group (172/565, 30.4%, vs 142/518, 27.4%; RR 0.99, 95% CI 0.97-1.02; P=.65). The intervention measures improved smoking cessation (44/565, 7.8%, vs 118/518, 22.8%; RR 0.48, 95% CI 0.44-0.53; P<.001) and alcohol restriction (33/565, 5.8%, vs 91/518, 17.6%; RR 0.47, 95% CI 0.42-0.54; P<.001). CONCLUSIONS The tertiary A-level hospital, WeChat-based intervention did not improve adherence to the 4 cardioprotective medications compared with the traditional method. Tertiary A-level hospital, WeChat-based interventions have a positive effect on improving lifestyle, such as quitting drinking and smoking, in patients with stable coronary artery disease and can be tried as a supplement to community hospital follow-up. CLINICALTRIAL ClinicalTrials.gov NCT04795505; https://clinicaltrials.gov/ct2/show/NCT04795505

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Adherence to Medical Treatment in Elderly Patients with Coronary Artery Disease in the Settings of Primary Outpatient Care

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2021-03-03 ◽

2021 ◽

Vol 17 (2) ◽

pp. 178-185

Author(s):

S. K. Zyryanov ◽

S. B. Fitilev ◽

A. V. Vozzhaev ◽

I. I. Shkrebneva ◽

N. N. Shindryaeva ◽

...

Keyword(s):

Primary Care ◽

Coronary Artery Disease ◽

Coronary Artery ◽

General Practitioner ◽

Elderly Patients ◽

Medical History ◽

Mean Values ◽

Artery Disease ◽

Provision Program ◽

Morisky Scale

Aim. To study medication adherence in elderly patients with coronary artery disease (CAD) in primary care practice.Material and methods. The study conducted in out-patient clinic of Moscow city. 293 elderly (≥65 years) patients with established CAD included. The following patient data obtained via electronic medical record system: demography, medical history, modifiable risk factors and prescribed pharmacotherapy. Level of medication adherence measured by Morisky scale (MMAS-8) via telephone survey.Results. According to Morisky scale high adherence was identified in 146 (49.8%) elderly patients, moderate adherence – in 99 (33.8%) patients, low adherence – in 48 (16.4%) patients. Analysis of specific questions of the scale done in non-adherent patients revealed signs of unintentional non-adherence due to forgetfulness (45.9%) and signs of intentional non-adherence due to patients feeling worse (35.8%) or better (28.4%). By means of dichotomic interpretation of Morisky scale results the population under research was divided into two groups: 147 (50.2%) non-adherent patients and 146 (49.8%) – totally adherent patients. These groups were comparable in terms of sex (female 71.2 vs 68.0%; p>0.05) and age (median 73.5 vs 73.0 years; p>0.05) distribution, and medical history: myocardial infarction (39.0% vs 38.8%), atrial fibrillation (37.0 and 41.5%), chronic heart failure (90.4% vs 91.2%), diabetes (26.7% vs 24.5%). There were fewer smokers in adherent group (0.7% vs 6.5%; p<0.05). As primary antianginal pharmacotherapy adherent and non-adherent patients were equally prescribed beta-blockers (75.3% vs 75.5%; p>0.05). Drugs that improve prognosis were also prescribed comparably: antiplatelets (66.4% vs 61.9%; p>0.05), anticoagulants (36.3% vs 44.9%; p>0.05), statins (82.2% vs 79.6%; p>0.05), renin-angiotensin system inhibitors (89.0 and 87.8%; p>0.05). Adherent patients had lower mean values of lipids: total cholesterol (4.7±1.2 vs 5.2±1.4 mmol/l; p<0.05) and low density cholesterol (2.4±0.9 vs 2.8±1.2 mmol/l; p<0.05). Non-adherent elderly patients made more visits to general practitioner (median 5 vs 3 visits; p<0.05). Share of patients receiving drugs within supplementary pharmaceutical provision program was comparable in both groups (53.7% vs 50.7%; p>0.05).Conclusion. Half of elderly patients with CAD are non-adherent to treatment in primary care setting. Medical history and structure of pharmacotherapy do not influence level of adherence in this population. Among adherent patients fewer individuals smoke and mean values of lipids are lower. Non-adherent elderly patients cause higher load on general practitioner, supplementary pharmaceutical provision program provided no better adherence in the population under research.

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