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Löffler L, Gögenur I, Gögenur M. Correlations between preoperative statin treatment with short- and long-term survival following colorectal cancer surgery: a propensity score-matched national cohort study. Int J Colorectal Dis 2024; 39:60. [PMID: 38676763 PMCID: PMC11055774 DOI: 10.1007/s00384-024-04631-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION The pleiotropic effects of statins have attracted considerable attention in oncological treatment. Several preclinical and epidemiological studies have highlighted their potential anti-tumor properties in patients with colorectal cancer, although results have been conflicting. This study aimed to examine the association between statin exposure before colorectal cancer surgery with long and short-term survival outcomes. METHODS This retrospective propensity score-adjusted study was conducted on a Danish cohort of patients who underwent elective curative-intended surgery for stage I-III colorectal cancer in 2008-2020, using four national patient databases. The primary and secondary outcomes were overall, 90-day, and disease-free survival. Propensity scores were calculated using all available data to match patients with and without statin exposure in a 1:1 ratio. RESULTS Following propensity score matching, 7120 patients were included in the primary analysis. The median follow-up time was 5 years. A Cox proportional hazards model showed no statistically significant difference in overall survival between patients with or without statin exposure 365 days before surgery (HR 0.93, 95% CI 0.85-1.02) and no association with 90-day survival (OR 0.91, 95% CI 0.76-1.10). However, a subgroup analysis examining a 90-day exposure before surgery found a statistically significant association with increased overall survival (HR 0.85, 95% CI 0.77-0.93). CONCLUSION Although a subgroup of patients with a preoperative exposure time of 90 days showed statistically significant better overall survival, we found no statistically significant association between statin exposure 1 year before colorectal cancer surgery and overall survival.
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Affiliation(s)
- Lea Löffler
- Center for Surgical Science, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark.
| | - Ismail Gögenur
- Center for Surgical Science, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
- Danish Colorectal Cancer Group, Copenhagen, Denmark
| | - Mikail Gögenur
- Center for Surgical Science, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
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Pontinha VM, Patterson JA, Dixon DL, Carroll NV, Mays D, Barnes A, Farris KB, Holdford DA. Longitudinal medication adherence group-based trajectories of aging adults in the US: A retrospective analysis using monthly proportion of days covered calculations. Res Social Adm Pharm 2024; 20:363-371. [PMID: 38176956 DOI: 10.1016/j.sapharm.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND It is thought that half of the patients with chronic conditions are not adherent to their medications, which contributes to significant health and economic burden. Many studies estimate medication non-adherence by implementing a threshold of ≥80% of Proportion of Days Covered (PDC), categorizing patients as either adherent or non-adherent. Healthcare quality metrics pertaining to medication use are based on this dichotomous approach of medication adherence, including the Medicare Part D Star Ratings. Among others, the Medicare Part D Star Ratings rewards part D plan sponsors with quality bonus payments based on this dichotomous categorization of beneficiaries' medication adherence. OBJECTIVES Describe the longitudinal adherence trajectories of adults ≥65 years of age covered by Medicare for 3 classes of drugs in the Part D Star Ratings: diabetes medications, statins, and select antihypertensives. METHODS This study used Medicare healthcare administrative claims data linked to participants from the Health Retirement Study between 2008 and 2016. Group-based trajectory models (GBTM) elicited the number and shape of adherence trajectories from a sample of N = 11,068 participants for the three pharmacotherapeutic classes considered in this study. Medication adherence was estimated using monthly PDC. RESULTS GBTM were estimated for the sample population taking antihypertensives (n = 7,272), statins (n = 8,221), and diabetes medications (n = 3,214). The hypertension model found three trajectories: high to very high adherence (47.55%), slow decline (32.99%), and rapid decline (19.47%) trajectories. The statins model found 5 trajectories: high to very high adherence (35.49%), slow decline (17.12%), low then increasing adherence (23.58%), moderate decline (12.62%), and rapid decline (11.20%). The diabetes medications model displayed 6 trajectories: high to very high adherence (24.15%), slow decline (16.84%), high then increasing adherence (25.56%), low then increasing (13.58%), moderate decline (10.60%), and rapid decline (9.27%). CONCLUSIONS This study showed the fluid nature of long-term medication adherence to the medications considered in the Medicare Part D Star Ratings and how it varies by pharmacotherapeutic class. These challenge previous assumptions about which patients were considered adherent to chronic medications. Policy and methodological implications about medication adherence are discussed.
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Affiliation(s)
- Vasco M Pontinha
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 North 12th Street, Richmond, VA, 23298-0533, USA; Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, 410 North 12th Street, Richmond, VA, 23298-0533, USA; University of Michigan College of Pharmacy, 428 Church St, Ann Arbor, MI, 48109-1065, USA.
| | - Julie A Patterson
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 North 12th Street, Richmond, VA, 23298-0533, USA.
| | - Dave L Dixon
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 North 12th Street, Richmond, VA, 23298-0533, USA; Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, 410 North 12th Street, Richmond, VA, 23298-0533, USA.
| | - Norman V Carroll
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 North 12th Street, Richmond, VA, 23298-0533, USA.
| | - D'Arcy Mays
- Department of Statistical Sciences and Operations Research, Virginia Commonwealth University College of Humanities & Sciences, 828 W Franklin St, Richmond, VA, 23220, USA.
| | - Andrew Barnes
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, USA.
| | - Karen B Farris
- University of Michigan College of Pharmacy, 428 Church St, Ann Arbor, MI, 48109-1065, USA.
| | - David A Holdford
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 North 12th Street, Richmond, VA, 23298-0533, USA; Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, 410 North 12th Street, Richmond, VA, 23298-0533, USA.
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Bélanger A, Desjardins C, Leblay L, Filiatrault M, Barbier O, Gangloff A, Leclerc J, Lefebvre J, Zongo A, Drouin-Chartier JP. Relationship Between Diet Quality and Statin Use Among Adults With Metabolic Syndrome From the CARTaGENE Cohort. CJC Open 2024; 6:11-19. [PMID: 38313338 PMCID: PMC10837700 DOI: 10.1016/j.cjco.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/24/2023] [Indexed: 02/06/2024] Open
Abstract
Background In metabolic syndrome (MetS), cardiovascular disease (CVD) risk reduction relies on the complementary use of diet and lipid-lowering medication. Evidence suggests that initiating such medication may impede diet quality. The objective of this study was to evaluate the relationship between diet quality and statin use among adults with MetS and free of CVD from the Province of Québec. Methods This cross-sectional study included 2481 adults with MetS (40-69 years of age) from the CARTaGENE Québec population-based cohort, of whom 463 self-reported using statin monotherapy. Diet was assessed using the Canadian Dietary History Questionnaire II, a food- frequency questionnaire, and diet quality was assessed using the Alternative Healthy Eating Index (AHEI). Results In multivariable-adjusted linear regression models, statin users had lower AHEI (%) compared with nonusers (users: 40.0; 95% confidence interval [CI], 38.9, 41.2 vs nonusers: 41.2; 95% CI, 40.4, 42.0; P = 0.03] because of a lower consumption of vegetables and whole grains. Stratified interaction analyses showed that the lower diet quality among statin users was mostly prevalent among men aged ≥ 50 years and women aged ≥ 60 years, among individuals with annual household incomes of < $50,000 and persons who self-reported history of high blood pressure. Conclusions In this cohort of adults with MetS from Quebéc, the use of statin monotherapy in primary prevention of CVD was associated with a slightly lower diet quality. These data suggest suboptimal complementarity between diet quality and use of cholesterol-lowering medication in primary prevention of CVD in MetS.
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Affiliation(s)
- Amélie Bélanger
- NUTRISS (Nutrition, Health and Society) Research Centre, Institute on Nutrition and Functional Foods, Laval University, Québec City, Québec, Canada
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
| | - Clémence Desjardins
- NUTRISS (Nutrition, Health and Society) Research Centre, Institute on Nutrition and Functional Foods, Laval University, Québec City, Québec, Canada
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
| | - Lise Leblay
- NUTRISS (Nutrition, Health and Society) Research Centre, Institute on Nutrition and Functional Foods, Laval University, Québec City, Québec, Canada
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
| | | | - Olivier Barbier
- NUTRISS (Nutrition, Health and Society) Research Centre, Institute on Nutrition and Functional Foods, Laval University, Québec City, Québec, Canada
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
- CHU de Québec-Laval University Research Center, Québec City, Québec, Canada
| | - Anne Gangloff
- CHU de Québec-Laval University Research Center, Québec City, Québec, Canada
- Faculty of Medicine, Laval University, Québec City, Québec, Canada
| | - Jacinthe Leclerc
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
- Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Jean Lefebvre
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
| | - Arsène Zongo
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
- CHU de Québec-Laval University Research Center, Québec City, Québec, Canada
| | - Jean-Philippe Drouin-Chartier
- NUTRISS (Nutrition, Health and Society) Research Centre, Institute on Nutrition and Functional Foods, Laval University, Québec City, Québec, Canada
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
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Desjardins C, Leblay L, Bélanger A, Filiatrault M, Barbier O, Guénette L, Leclerc J, Lefebvre J, Zongo A, Drouin-Chartier JP. Relationship Between Diet Quality and Glucose-Lowering Medication Intensity Among Adults With Type 2 Diabetes: Results From the CARTaGENE Cohort. CJC Open 2024; 6:20-29. [PMID: 38313340 PMCID: PMC10837702 DOI: 10.1016/j.cjco.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/24/2023] [Indexed: 02/06/2024] Open
Abstract
Background In real-world settings, whether diet and medication are used as complements for glycemic management in type 2 diabetes (T2D) remains unclear. This study assessed the relationship between diet quality and intensity of glucose-lowering medication among adults with T2D. Methods This cross-sectional study included 352 adults with T2D from the CARTaGENE Québec population-based cohort. Diet quality was assessed using the Healthful Plant-Based Diet Index (hPDI). Glucose-lowering medication intensity was graded according to self-reported information on the type and number of drugs: no medication; oral monotherapy; oral polytherapy; and insulin with and without oral medication. In the subsample of 239 individuals who reported the medication dosages, intensity was also graded using the Medication Effect Score (MES). Results In multivariable-adjusted models, we found no evidence of a relationship between the hPDI and medication intensity, assessed using the categorical approach (Pbetween-group = 0.25) or the MES (P = 0.43). However, the hPDI was inversely associated with the MES among men < 50 years of age and women < 60 years (β1-point MES = -2.24 [95% confidence interval, -4.46, -0.02] hPDI points), but not among older individuals (β = -0.03 [-1.28, 1.21] hPDI points). Evidence of a nonsignificant inverse relationship between the hPDI and HbA1c was observed (β10-point hPDI = -0.23% [-0.63, 0.17]), whereas a positive and significant association between the MES and hemoglobin (Hb)A1c was found (β1-point MES = 0.30% [0.10, 0.51]). Conclusions In this cohort of adults with T2D, there was an overall lack of complementarity between diet quality and intensity of glucose-lowering medication. The issue was particularly important among younger adults for whom diet quality was inversely associated with intensity of medication.
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Affiliation(s)
- Clémence Desjardins
- Nutrition, Health and Society (NUTRISS) Research Center, Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, Québec, Canada
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
| | - Lise Leblay
- Nutrition, Health and Society (NUTRISS) Research Center, Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, Québec, Canada
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
| | - Amélie Bélanger
- Nutrition, Health and Society (NUTRISS) Research Center, Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, Québec, Canada
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
| | | | - Olivier Barbier
- Nutrition, Health and Society (NUTRISS) Research Center, Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, Québec, Canada
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
- CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada
| | - Line Guénette
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
- CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada
| | - Jacinthe Leclerc
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Jean Lefebvre
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
| | - Arsène Zongo
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
- CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada
| | - Jean-Philippe Drouin-Chartier
- Nutrition, Health and Society (NUTRISS) Research Center, Institute of Nutrition and Functional Foods (INAF), Laval University, Québec City, Québec, Canada
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
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Chen Y, Gao J, Lu M. Medication adherence trajectory of patients with chronic diseases and its influencing factors: A systematic review. J Adv Nurs 2024; 80:11-41. [PMID: 37408103 DOI: 10.1111/jan.15776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
AIMS To synthesize the published studies on medication adherence trajectories among patients with chronic diseases and identify the influencing factors. DESIGN Systematic review. DATA SOURCES Medline (Ovid), Embase (Ovid) and Web of Science core collection were searched from database inception to 1 July 2022. REVIEW METHODS Potentially eligible articles were independently screened by three reviewers using set inclusion and exclusion criteria. The Joanna Briggs Institute critical appraisal checklist for cohort studies was used to appraise the quality of the included articles. Three reviewers independently evaluated the quality, extracted data and resolved differences by consensus. Results were presented using descriptive synthesis, and the prevalence of recategorised medication adherence trajectories was calculated from the published data. RESULTS Fifty studies were included. Medication adherence trajectories among patients with chronic diseases were synthesized into six categories: adherence, non-adherence, decreasing adherence, increasing adherence, fluctuating adherence and moderate adherence. Low and moderate evidence showed that (1) patient-related factors, including age, sex, race, marital status and mental status; (2) healthcare team and system-related factors, including healthcare utilization, insurance and primary prescriber specialty; (3) socioeconomic factors including education, income and employment status; (4) condition-related factors including complications and comorbidities and (5) therapy-related factors including the number of medications, use of other medications, and prior medication adherence behaviours were factors influencing the medication adherence trajectory. Marital status and prior medication adherence behaviour were the only influencing factors with moderate evidence of an effect. CONCLUSION The medication adherence trajectory among patients with chronic diseases varied widely. Further studies are warranted to determine contributory factors. IMPLICATIONS FOR THE PROFESSION Healthcare providers should be aware that patients' medication adherence has different trajectories and should take appropriate measures to improve patients' medication adherence patterns. PATIENT OR PUBLIC CONTRIBUTION None. As a systematic review, patients and the public were not involved.
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Affiliation(s)
- Yu Chen
- School of Nursing, Fudan University, Shanghai, China
| | - Jing Gao
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minmin Lu
- School of Nursing, Fudan University, Shanghai, China
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Roetzheim A, Snow S, Gonzalez E, Guerra L, Petrilli J. Assessing Adherence to Statin Prescription Guidelines at a Student-Run Free Clinic: A Retrospective Review. Cureus 2023; 15:e43083. [PMID: 37680424 PMCID: PMC10482308 DOI: 10.7759/cureus.43083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE The goals of this quality improvement project are to assess the BRIDGE Student-Run Free Clinic's adherence to the 2019 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on the Primary Prevention of Cardiovascular Disease and to compare our rate of statin prescription to the national average and to uninsured groups. METHODS A quality improvement project of 205 patients qualified by initial inclusion criteria at a student-run free healthcare clinic. Socio-demographic information, clinical measures associated with cardiovascular risk, and documentation regarding statin prescription at the follow-up visit after a patient's first lipid panel were abstracted from medical records. Descriptive statistics were calculated on the sample (proportions, means), and the proportion of patients eligible for statin treatment was determined. RESULTS Of 58 patients eligible by guidelines to receive statins, 29 received a statin (50%) at their follow-up visit. Patients with clinical atherosclerotic cardiovascular disease (ASCVD) were more likely to receive statin therapy (83.3%) compared to other groups. Patients who were prescribed a statin were older, had higher total cholesterol, higher low-density lipoprotein (LDL), higher systolic blood pressure, and had higher ASCVD risk. Patients receiving statins were also more likely to be male or have a history of either hypertension, diabetes, or clinical ASCVD. CONCLUSION Patients with established ASCVD had high rates of statin prescription. Following the first lipid panel, clinicians prescribed statins to approximately 50% of eligible patients. Although this proportion is below the national average for insured patients, it is higher than the national average for uninsured patients and represents a relatively high proportion of eligible patients within the examined time frame.
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Affiliation(s)
- Alex Roetzheim
- Department of Family Medicine, Florida State University College of Medicine, Tallahassee, USA
| | - Sam Snow
- Department of Family Medicine, Florida State University College of Medicine, Tallahassee, USA
| | - Eduardo Gonzalez
- Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Lucy Guerra
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - John Petrilli
- Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
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Ramsing MS, Kraglund F, Jepsen P. Prevalence of Statin Use and Predictors of Statin Initiation Among Patients with Alcohol-Related Cirrhosis - A Danish Nationwide Cohort Study. Clin Epidemiol 2023; 15:435-446. [PMID: 37033124 PMCID: PMC10076903 DOI: 10.2147/clep.s401862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/09/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose Statins reportedly increase the survival of patients with cirrhosis due to alcohol-related liver disease (ALD cirrhosis), but this association might be confounded by socioeconomic status. We examined the prevalence of statin use and socioeconomic and demographic predictors of statin initiation and discontinuation among patients with ALD cirrhosis. Patients and Methods Using Danish nationwide healthcare registries, we examined statin use among patients diagnosed with ALD cirrhosis in 1997-2018. We computed the prevalence of statin use and incidence of statin initiation and discontinuation, and we used multivariable Cox regression to identify predictors of statin initiation and discontinuation. Results We identified 28,260 patients with ALD cirrhosis in 1997-2018. During this period, the prevalence of statin use rose sharply, reaching 19.0% in late 2018. Among patients diagnosed with ALD cirrhosis after 2010, 16.9% were using statins when they were diagnosed with cirrhosis. Among the patients who did not use statins initially, those with lower educational attainment were more likely to begin taking them than those with higher attainment. Also, cohabiting patients were more likely to begin than patients who lived alone, and employed patients were more likely to begin compared to patients outside the labour force. Among current statin users, unemployment predicted statin discontinuation. Conclusion The use of statins has become increasingly prevalent among Danish patients with ALD cirrhosis, reaching 19.0% in 2018. Employment, cohabitation, and a short education predicted statin initiation after ALD cirrhosis diagnosis, and unemployment predicted statin discontinuation. Overall, statin use was not a marker of a high socioeconomic status.
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Affiliation(s)
- Marine Sølling Ramsing
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Correspondence: Marine Sølling Ramsing, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, 8200, Denmark, Tel +45 78 45 00 00, Email
| | - Frederik Kraglund
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Cupido AJ, Hof MH, de Boer LM, Huijgen R, Stroes ESG, Kastelein JJP, Hovingh GK, Hutten BA. Adherence to statin treatment in patients with familial hypercholesterolemia: A dynamic prediction model. J Clin Lipidol 2023; 17:236-243. [PMID: 36697324 DOI: 10.1016/j.jacl.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/12/2022] [Accepted: 12/11/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Statins are the primary therapy in patient with heterozygous familial hypercholesterolemia (HeFH). Non-adherence to statin therapy is associated with increased cardiovascular risk. OBJECTIVE We constructed a dynamic prediction model to predict statin adherence for an individual HeFH patient for each upcoming statin prescription. METHODS All patients with HeFH, identified by the Dutch Familial Hypercholesterolemia screening program between 1994 and 2014, were eligible. National pharmacy records dated between 1995 and 2015 were linked. We developed a dynamic prediction model that estimates the probability of statin adherence (defined as proportion of days covered >80%) for an upcoming prescription using a mixed effect logistic regression model. Static and dynamic patient-specific predictors, as well as data on a patient's adherence to past prescriptions were included. The model with the lowest AIC (Akaike Information Criterion) value was selected. RESULTS We included 1094 patients for whom 21,171 times a statin was prescribed. Based on the model with the lowest AIC, age at HeFH diagnosis, history of cardiovascular event, time since HeFH diagnosis and duration of the next statin prescription contributed to an increased adherence, while adherence decreased with higher untreated LDL-C levels and higher intensity of statin therapy. The dynamic prediction model showed an area under the curve of 0.63 at HeFH diagnosis, which increased to 0.85 after six years of treatment. CONCLUSION This dynamic prediction model enables clinicians to identify HeFH patients at risk for non-adherence during statin treatment. These patients can be offered timely interventions to improve adherence and further reduce cardiovascular risk.
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Affiliation(s)
- Arjen J Cupido
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands (Dr Cupido), (Drs Stroes, Kastelein, Hovingh); Department of Medicine, Division of Cardiology, University of California, Los Angeles, Los Angeles, CA, USA (Dr Cupido); Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (Dr Cupido).
| | - Michel H Hof
- Department of Epidemiology and Data Science, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands (Drs Hof, de Boer, Hutten)
| | - Lotte M de Boer
- Department of Epidemiology and Data Science, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands (Drs Hof, de Boer, Hutten)
| | - Roeland Huijgen
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem, the Netherlands (Dr Huijgen)
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands (Dr Cupido), (Drs Stroes, Kastelein, Hovingh)
| | - John J P Kastelein
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands (Dr Cupido), (Drs Stroes, Kastelein, Hovingh)
| | - G Kees Hovingh
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands (Dr Cupido), (Drs Stroes, Kastelein, Hovingh)
| | - Barbara A Hutten
- Department of Epidemiology and Data Science, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands (Drs Hof, de Boer, Hutten)
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Hughes K, Olufajo OA, White K, Roby DH, Fryer CS, Wright JL, Sehgal NJ. The Relationship Between Peripheral Arterial Disease Severity and Socioeconomic Status. Ann Vasc Surg 2023; 92:33-41. [PMID: 36736719 DOI: 10.1016/j.avsg.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although socioeconomic disparities in outcomes of peripheral artery disease (PAD) have been well studied, little is known about relationship between severity of PAD and socioeconomic status. The objective of this study was to examine this relationship. METHODS Patients who had operations for severe PAD (rest pain or tissue loss) were identified in the National Inpatient Sample, 2005-2014. They were stratified by the median household income (MHI) quartiles of their residential ZIP codes. Other characteristics such as race/ethnicity and insurance type were extracted. Factors associated with more severe disease (tissue loss) were evaluated using multivariable regression analyses. RESULTS There were 765,175 patients identified; 34% in the first MHI quartile and 18% in the fourth MHI quartile. Compared to patients in the first quartile, those in the fourth quartile were more likely White (69% vs. 42%, P < 0.001), more likely ≥65 years old (75% vs. 62%, P < 0.001), and were less likely to undergo amputations (25% vs. 34%, P < 0.001). After adjusting for patient characteristics, the fourth quartile was associated with more severe disease [Odds ratio: 1.19, 95% confidence interval (CI): 1.11-1.27] compared to the first quartile. CONCLUSIONS While higher MHI was associated with higher PAD severity, patients with high MHI were less likely to undergo amputations indicating a disparity in the choice of treatment for PAD. Increased efforts are necessary to reduce socioeconomic disparities in the treatment of severe PAD.
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Affiliation(s)
- Kakra Hughes
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD; Department of Surgery, Howard University College of Medicine, Washington, DC.
| | - Olubode A Olufajo
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Kellee White
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD
| | - Dylan H Roby
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD
| | - Craig S Fryer
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD
| | - Joseph L Wright
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD; University of Maryland Capital Region Health, Cheverly, MD
| | - Neil J Sehgal
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD
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Sanders KM, Nacario JH, Smith EJT, Jaramillo EA, Lancaster EM, Hiramoto JS, Conte MS, Iannuzzi JC. Structured discharge documentation reduces sex-based disparities in statin prescription in vascular surgery patients. J Vasc Surg 2023; 77:1504-1511. [PMID: 36682597 DOI: 10.1016/j.jvs.2023.01.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Perioperative statin use has been shown to improve survival in vascular surgery patients. In 2018, the Northern California Vascular Study Group implemented a quality initiative focused on the use of a SmartText in the discharge summary. We hypothesized that structured discharge documentation would decrease sex-based disparities in evidence-based medical therapy. METHODS A retrospective analysis was conducted using Vascular Quality Initiative eligible cases at a single institution. Open or endovascular procedures in the abdominal aorta or lower extremity arteries from 2016 to 2021 were included. Bivariate analysis identified factors associated with statin use and sex. Multivariate logistic regression was performed with the end point of statin prescription at discharge and aspirin prescription at discharge. An interaction term assessed the differential impact of the initiative on both sexes. Analysis was then stratified by prior aspirin or statin prescription. An interrupted time series analysis was used to evaluate the trend in statin prescription over time. RESULTS Overall, 866 patients were included, including 292 (34%) female and 574 (66%) male patients. Before implementation, statins were prescribed in 77% of male and 62% of female patients (P < .01). After implementation, there was no statistically significant difference in statin prescription (91% in male vs 92% in female patients, P = .68). Female patients saw a larger improvement in the adjusted odds of statin prescription compared with male patients (odds ratio: 3.1, 95% confidence interval: 1.1-8.6, P = .04). For patients not prescribed a statin preoperatively, female patients again saw an even larger improvement in the odds of being prescribed a statin at discharge (odds ratio: 6.4, 95% confidence interval: 1.8-22.7, P < .01). Interrupted time series analysis demonstrated a sustained improvement in the frequency of prescription for both sexes over time. The unadjusted frequency of aspirin prescription also improved by 3.5% in male patients vs 5.5% in female patients. For patients not prescribed an aspirin preoperatively, we found that the frequency of aspirin prescription significantly improved for both male (19% increase, P = .006) and female (31% increase, P = .001) patients. There was no significant difference in the perioperative outcomes between male and female patients before and after standardized discharge documentation. CONCLUSIONS A simple, low-cost regional quality improvement initiative eliminated sex-based disparities in statin prescription at a single institution. These findings highlight the meaningful impact of regional quality improvement projects. Future studies should examine the potential for structured discharge documentation to improve patient outcomes and reduce disparities.
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Affiliation(s)
- Katherine M Sanders
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA
| | - Joyce H Nacario
- Heart and Vascular Services, Department of Quality & Patient Safety, University of California, San Francisco, CA
| | - Eric J T Smith
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA
| | - Emanuel A Jaramillo
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA
| | - Elizabeth M Lancaster
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA
| | - Jade S Hiramoto
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA
| | - Michael S Conte
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA
| | - James C Iannuzzi
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA.
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11
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Variation in statin prescription among veterans with HIV and known atherosclerotic cardiovascular disease. Am Heart J 2022; 249:12-22. [PMID: 35318028 PMCID: PMC9976623 DOI: 10.1016/j.ahj.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND People with HIV have increased atherosclerotic cardiovascular disease (ASCVD) risk, worse outcomes following incident ASCVD, and experience gaps in cardiovascular care, highlighting the need to improve delivery of preventive therapies in this population. OBJECTIVE Assess patient-level correlates and inter-facility variations in statin prescription among Veterans with HIV and known ASCVD. METHODS We studied Veterans with HIV and existing ASCVD, ie, coronary artery disease (CAD), ischemic cerebrovascular disease (ICVD), and peripheral arterial disease (PAD), who received care across 130 VA medical centers for the years 2018-2019. We assessed correlates of statin prescription using two-level hierarchical multivariable logistic regression. Median odds ratios (MORs) were used to quantify inter-facility variation in statin prescription. RESULTS Nine thousand six hundred eight Veterans with HIV and known ASCVD (mean age 64.3 ± 8.9 years, 97% male, 48% Black) were included. Only 68% of the participants were prescribed any-statin. Substantially higher statin prescription was observed for those with diabetes (adjusted odds ratio [OR] = 2.3, 95% confidence interval [CI], 2.0-2.6), history of coronary revascularization (OR = 4.0, CI, 3.2-5.0), and receiving antiretroviral therapy (OR = 3.0, CI, 2.7-3.4). Blacks (OR = 0.7, CI, 0.6-0.9), those with non-coronary ASCVD, ie, ICVD and/or PAD only, (OR 0.53, 95% CI: 0.48-0.57), and those with history of illicit substance use (OR=0.7, CI, 0.6-0.9) were less likely to be prescribed statins. There was significant variation in statin prescription across VA facilities (10th, 90th centile: 55%, 78%), with an estimated 20% higher likelihood of difference in statin prescription practice for two clinically similar individuals treated at two comparable facilities (adjusted MOR = 1.21, CI, 1.18-1.24), and a greater variation observed for Blacks or those with non-coronary ASCVD or history of illicit drug use. CONCLUSION In an analysis of large-scale VA data, we found suboptimal statin prescription and significant interfacility variation in statin prescription among Veterans with HIV and known ASCVD, particularly among Blacks and those with a history of non-coronary ASCVD.
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12
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Hawley CE, Lauffenburger JC, Paik JM, Wexler DJ, Kim SC, Patorno E. Three Sides to the Story: Adherence Trajectories During the First Year of SGLT2 Inhibitor Therapy Among Medicare Beneficiaries. Diabetes Care 2022; 45:604-613. [PMID: 35043165 PMCID: PMC8918201 DOI: 10.2337/dc21-1676] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/10/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We aimed to understand the factors associated with sodium-glucose cotransporter 2 inhibitor (SGLT2i) adherence and longitudinal adherence trajectories in older adults with type 2 diabetes. RESEARCH DESIGN AND METHODS Using Medicare claims data (April 2013-December 2017), we identified 83,675 new SGLT2i users ≥66 years old with type 2 diabetes. We measured SGLT2i adherence as the proportion of days covered (PDC) during the first year of SGLT2i therapy. We used linear regression to assess the association between baseline covariates and PDC. Then we used group-based trajectory modeling to identify distinct longitudinal SGLT2i adherence groups and used a multivariable logistic regression model to examine the association between baseline covariates and membership in these adherence groups. RESULTS Unadjusted mean PDC was 63%. Previous adherence to statins had the strongest positive association with PDC (regression coefficient 6.00% [95% CI 5.50, 6.50]), whereas female sex (-5.51% [-6.02, -5.00]), and Black race/ethnicity (-5.06% [-6.03, -4.09]) had the strongest negative association. We identified three adherence trajectory groups: low (23% of patients, mean PDC 17%), moderate (32%, mean PDC 50%), and high (45%, mean PDC 96%) adherence. More patients in the high adherence group were previously adherent to statins (odds ratio 1.43 [95% CI 1.39, 1.48]), and more women (1.28 [1.23, 1.32]) and Black patients (1.31 [1.23, 1.40]) were in the low adherence group. CONCLUSIONS In a large population of older patients with type 2 diabetes, 45% were highly adherent during the first year of SGLT2i treatment. Female sex and Black race/ethnicity were most strongly associated with low adherence.
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Affiliation(s)
- Chelsea E Hawley
- New England Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston.,Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Julie C Lauffenburger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Julie M Paik
- New England Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston.,Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Deborah J Wexler
- Diabetes Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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13
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Identifying temporal patterns of adherence to antidepressants, bisphosphonates and statins, and associated patient factors. SSM Popul Health 2022; 17:100973. [PMID: 35106359 PMCID: PMC8784627 DOI: 10.1016/j.ssmph.2021.100973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background Group-based trajectory modelling (GBTM) has recently been explored internationally as an improved approach to measuring medication adherence (MA) by differentiating between alternative temporal patterns of nonadherence. To build on this international research, we use the method to identify temporal patterns of medication adherence to antidepressants, bisphosphonates or statins, and their associations with patient characteristics. Objectives The objectives include identification of MA types using GBTM, exploration of features and associated patient characteristics of each MA type, and identification of the advantages of GBTM compared to the traditional proportion of days covered (PDC) measure. Data and methods We used 45 and Up Study survey data which contains information about demographics, family, health, diet, work and lifestyle of 267,153 participants aged at least 45 years across New South Wales, Australia. This data was linked to participant records of medication use, outpatient and inpatient care, and death. Our study participants initiated use of antidepressants (9287 participants), bisphosphonates (1660 participants) or statins (10,242 participants) during 2012–2016. MA types were identified from 180-day patterns of medication use for antidepressants and 360-day patterns for bisphosphonates and statins. Multinomial and binomial logistic regressions were performed to estimate participant characteristics associated with GBTM MA and PDC MA, respectively. Results Three GBTM MA types were identified for antidepressants and six for bisphosphonates and statins. For all three medications, MA types included: almost fully adherent; decreasing adherence and early discontinuation. The additional nonadherent types for bisphosphonates and statins were improved adherence, low adherence and later discontinuation. Participant characteristics impacting GBTM MA and PDC MA were consistent. However, several associations were uniquely found for GBTM MA as compared to PDC MA. Conclusion GBTM permits clinicians, policy-makers and researchers to differentiate between alternative nonadherence patterns, allowing them to better identify patients at risk of poor adherence and tailor interventions accordingly. Medication adherence was categorised using group-based trajectory modelling (GBTM). GBTM categories include adherence, early discontinuation and decreasing adherence. Demographic, economic, health and other factors determined GBTM categories. GBTM provides additional information to better target adherence interventions.
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14
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Argnani L, Zanetti A, Carrara G, Silvagni E, Guerrini G, Zambon A, Scirè CA. Rheumatoid Arthritis and Cardiovascular Risk: Retrospective Matched-Cohort Analysis Based on the RECORD Study of the Italian Society for Rheumatology. Front Med (Lausanne) 2021; 8:745601. [PMID: 34676228 PMCID: PMC8523847 DOI: 10.3389/fmed.2021.745601] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/06/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) is associated with an increase in cardiovascular (CV) risk. This issue maybe not only explained by a genetic component, as well as by the traditional CV risk factors, but also by an underestimation and undertreatment of concomitant CV comorbidities. Method: This was a retrospective matched-cohort analysis in the Italian RA real-world population based on the healthcare-administrative databases to assess the CV risk factors and incidence of CV events in comparison with the general population. Persistence and adherence to the CV therapy were also evaluated in both groups. Results: In a RA cohort (N = 21,201), there was a greater prevalence of hypertension and diabetes with respect to the non-RA subjects (N = 249,156) (36.9 vs. 33.4% and 10.2 vs. 9.6%, respectively), while dyslipidemia was more frequent in the non-RA group (15.4 vs. 16.5%). Compared with a non-RA cohort, the patients with RA had a higher incidence of atrial fibrillation (incidence rate ratio, IRR 1.28), heart failure (IRR 1.53), stroke (IRR 1.19), and myocardial infarction (IRR 1.48). The patients with RA presented a significantly lower persistence rate to glucose-lowering and lipid-lowering therapies than the controls (odds ratio, OR 0.73 [95% CI 0.6–0.8] and OR 0.82 [0.8–0.9], respectively). The difference in the adherence to glucose-lowering therapy was significant (OR 0.7 [0.6–0.8]), conversely no statistically significant differences emerged regarding the adherence to lipid-lowering therapy (OR 0.89 [95% CI 0.8–1.0]) and anti-hypertensive therapy (OR 0.96 [95% CI 0.9–1.0]). Conclusion: The patients with RA have a higher risk of developing CV events compared with the general population, partially explained by the excess and undertreatment of CV risk factors.
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Affiliation(s)
- Lisa Argnani
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Anna Zanetti
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy.,Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Ettore Silvagni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S.Anna, Cona, Italy
| | - Giulio Guerrini
- Biomedical and Biotechnological Science at Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy.,Internal Medicine, State Hospital, Borgo Maggiore, San Marino
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Carlo Alberto Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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15
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Multiple Socioeconomic Circumstances and Initiation of Cardiovascular Medication among Ageing Employees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910148. [PMID: 34639449 PMCID: PMC8507630 DOI: 10.3390/ijerph181910148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/24/2021] [Accepted: 09/22/2021] [Indexed: 12/31/2022]
Abstract
There are persisting socioeconomic differences in cardiovascular diseases, but studies on socioeconomic differences in the initiation of cardiovascular medication are scarce. This study examined the associations between multiple socioeconomic circumstances and cardiovascular medication. The Helsinki Health Study baseline survey (2000-2002) of 40-60-year-old employees was linked with cardiovascular medication data from national registers. The analyses included 5805 employees concerning lipid medication and 4872 employees concerning hypertension medication. Medication purchases were followed for 10 years. The analyses were made using logistic regression, and the odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for childhood, conventional and material socioeconomic circumstances. Low parental education showed an association with lipid medication among women only (OR 1.34, 95% CI 1.11-1.61), whereas childhood economic difficulties showed more widespread associations. Low education and occupational class were associated with an increased risk of both hypertension (education: OR 1.58, 1.32-1.89; occupational class: 1.31, 1.08-1.59) and lipid medication (education: 1.34, 1.12-1.61; occupational class: 1.38, 1.13-1.67). Rented housing (1.35, 1.18-1.54 for hypertension medication; 1.21, 1.05-1.38 for lipid medication) and current economic difficulties (1.59, 1.28-1.98 for hypertension medication; 1.35, 1.07-1.71 for lipid medication) increased the risk. Several measures of socioeconomic circumstances acting at different stages of the life course were associated with cardiovascular medication, with individuals in disadvantageous socioeconomic circumstances having elevated risks.
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16
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Majd Z, Mohan A, Abughosh SM. Using group-based trajectory modeling to characterize the association of past ACEIs/ARBs adherence with subsequent statin adherence patterns among new statin users. J Am Pharm Assoc (2003) 2021; 61:829-837.e2. [PMID: 34344613 DOI: 10.1016/j.japh.2021.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/21/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite well-documented benefits, statin adherence remains suboptimal. Studies have suggested that previous adherence to other chronic medications is a strong predictor of future adherence to newly initiated statins. Group-based trajectory modeling (GBTM) has been applied as a method to longitudinally depict the dynamic nature of adherence. OBJECTIVES This study aimed to examine the association between patients' adherence patterns to newly initiated statins and previous adherence trajectories of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) using GBTM. METHODS This retrospective cohort study was conducted among continuously enrolled statin initiators using claims data. Patients were included if they had ACEI/ARB use within 1 year before statin initiation (preindex period). Monthly adherence to ACEIs/ARBs was calculated during the preindex period and monthly adherence to statins was assessed 1 year after statin initiation using proportion of days covered (PDC). The monthly PDCs were modeled as a longitudinal response in a logistic GBTM to provide distinct patterns of adherence for ACEIs/ARBs and statins, separately. A multinomial logistic regression was conducted to determine an association between ACEI/ARB adherence trajectories and future statin trajectories, controlling for patient characteristics. RESULTS A total of 1078 patients were categorized into 4 distinct statin adherence trajectories: adherent (40.8%), gradual decline (37.4%), gaps in adherence (13.9%), and rapid decline (7.9%). Patients were further categorized into 4 groups on the basis of their distinct past ACEIs/ARBs trajectories: adherent (43%), gaps in adherence (29%), delayed nonadherence (15.2%), and gradual decline (12.8%). In the multinomial logistic regression, patients in the gaps in adherence or gradual decline groups were more likely to follow similar trajectories for future statin use than the adherent trajectory. CONCLUSION Previous adherence trajectories of ACEIs/ARBs may predict future adherence patterns for newly initiated statins. Knowledge of past medication-taking behavior could provide valuable information for developing tailored interventions to improve adherence.
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17
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Sederholm Lawesson S, Swahn E, Alfredsson J. Adherence to Study Drugs: A Matter of Sex? Circulation 2021; 143:696-698. [PMID: 33587664 DOI: 10.1161/circulationaha.121.053493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sofia Sederholm Lawesson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Eva Swahn
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Joakim Alfredsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
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18
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Momo K, Yasu T, Sasaki T. [Development and Application for Drug-safety and Efficacy Using a Large Claims Data]. YAKUGAKU ZASSHI 2021; 141:175-178. [PMID: 33518636 DOI: 10.1248/yakushi.20-00196-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recent years, evidences for medical safety and efficacy are accelerated-developing using medical big data. Medical big data were adequate for analyzing 1) rare events that difficult for finding in each hospital, 2) for comparison of bench marks obtained routine work between average data in large number of hospitals and specific hospital data and 3) prescription surveys etc. As so far, these analyses using medical big data were conducted by academia and/or researcher. However, in these days, evidences using medical big data were focused on hospital pharmacists little by little. In this review, we show 3 researches using large claims data such as 1) risk factors assessing for failed low-density lipoprotein level achievement in members of the working-age population, 2) prevalence of drug-drug interaction in atrial fibrillation patients and 3) assessment of "look-alike" packaging designs related to medication errors using information technology and large claims data. Medical big data such as large claims data analysis is useful and suitable for building evidences according to medical staffs-needs.
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Affiliation(s)
- Kenji Momo
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
| | - Takeo Yasu
- Department of Medicinal Therapy Research, Pharmaceutical Education and Research Center, Meiji Pharmaceutical University
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19
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Claessen BE, Guedeney P, Gibson CM, Angiolillo DJ, Cao D, Lepor N, Mehran R. Lipid Management in Patients Presenting With Acute Coronary Syndromes: A Review. J Am Heart Assoc 2020; 9:e018897. [PMID: 33289416 PMCID: PMC7955383 DOI: 10.1161/jaha.120.018897] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite many improvements in its prevention and management, acute coronary syndrome (ACS) remains a major cause of morbidity and mortality in the developed world. Lipid management is an important part of secondary prevention after ACS, but many patients currently remain undertreated and do not attain guideline‐recommended levels of low‐density lipoprotein cholesterol reduction. This review details the current state of evidence on lipid management in patients presenting with ACS, provides directions for identification of patients who may benefit from early escalation of lipid‐lowering therapy, and discusses novel lipid‐lowering medication that is currently under investigation in clinical trials. Moreover, a treatment algorithm aimed at attaining guideline‐recommended low‐density lipoprotein cholesterol levels is proposed. Despite important advances in the initial treatment and secondary prevention of ACS, ≈20% of ACS survivors experience a subsequent ischemic cardiovascular event within 24 months, and 5‐year mortality ranges from 19% to 22%. Knowledge of the current state of evidence‐based lipid management after ACS is of paramount importance to improve outcomes after ACS.
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Affiliation(s)
- Bimmer E Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY.,Noordwest Ziekenhuisgroep Alkmaar the Netherlands
| | - Paul Guedeney
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY.,ACTION Study Group Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche Scientifique_1166 Cardiology Institute Pitié Salpêtrière Hospital ParisSorbonne University Paris France
| | | | | | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Norman Lepor
- Cedars-Sinai Heart InstituteGeffen School of Medicine-University of Califonia - Los Angeles Los Angeles CA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
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20
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Sigglekow F, Horsburgh S, Parkin L. Statin adherence is lower in primary than secondary prevention: A national follow-up study of new users. PLoS One 2020; 15:e0242424. [PMID: 33211724 PMCID: PMC7676659 DOI: 10.1371/journal.pone.0242424] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 11/02/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Maintaining adherence to statins reduces the risk of an initial cardiovascular disease (CVD) event in high-risk individuals (primary prevention) and additional CVD events following the first event (secondary prevention). The effectiveness of statin therapy is limited by the level of adherence maintained by the patient. We undertook a nationwide study to compare adherence and discontinuation in primary and secondary prevention patients. METHODS Dispensing data from New Zealand community pharmacies were used to identify patients who received their first statin dispensing between 2006 and 2011. The Medication Possession Ratio (MPR) and proportion who discontinued statin medication was calculated for the year following first statin dispensing for patients with a minimum of two dispensings. Adherence was defined as an MPR ≥ 0.8. Previous CVD was identified using hospital discharge records. Multivariable logistic regression was used to control for demographic and statin characteristics. RESULTS Between 2006 and 2011 289,666 new statin users were identified with 238,855 (82.5%) receiving the statin for primary prevention compared to 50,811 (17.5%) who received it for secondary prevention. The secondary prevention group was 1.55 (95% CI 1.51-1.59) times as likely to be adherent and 0.67 (95% CI 0.65-0.69) times as likely to discontinue statin treatment than the primary prevention group. An early gap in statin coverage increased the odds of discontinuing statin treatment. CONCLUSION Adherence to statin medication is higher in secondary prevention than primary prevention. Within each group, a range of demographic and treatment factors further influences adherence.
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Affiliation(s)
- Finn Sigglekow
- Department of Preventive and Social Medicine, Otago Medical School—Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Simon Horsburgh
- Department of Preventive and Social Medicine, Otago Medical School—Dunedin Campus, University of Otago, Dunedin, New Zealand
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- * E-mail:
| | - Lianne Parkin
- Department of Preventive and Social Medicine, Otago Medical School—Dunedin Campus, University of Otago, Dunedin, New Zealand
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
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21
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Alhazami M, Pontinha VM, Patterson JA, Holdford DA. Medication Adherence Trajectories: A Systematic Literature Review. J Manag Care Spec Pharm 2020; 26:1138-1152. [PMID: 32857646 PMCID: PMC10391275 DOI: 10.18553/jmcp.2020.26.9.1138] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Traditional adherence measures such as proportion of days covered (PDC) and medication possession ratio (MPR) are limited in their ability to explain patient medication adherence over time. Group-based trajectory modeling (GBTM) is a new methodological approach that visually describes the dynamics of long-term medication adherence and classifies adherence behavior into groups. OBJECTIVES To describe and compare trajectories of medication nonadherence reported in the medical literature, including identifying consistent trends in adherence trajectories and disease and patient characteristics that predict trajectory group membership. METHODS A systematic literature review was conducted in April 2020 in PubMed and CINAHL using MeSH terms and key words in appropriate combinations. Citations were screened for relevance using predefined inclusion and exclusion criteria and evaluated according to variables associated with group-based trajectory models. RESULTS 21 articles met the study criteria and were reviewed. Generally, studies identified 4 to 6 trajectory groups that described longitudinal medication adherence behavior. Most commonly identified trajectories were labeled as (a) consistent, high adherence, (b) declining adherence, (c) early and consistent nonadherence, and (d) initial nonadherence followed by an increase. Several predictors, including socioeconomic status, disease characteristics, and therapy initiation were routinely associated with group membership. CONCLUSIONS This review suggests that adherence trajectories and predictors of specific group membership may be similar across diverse disease states. GBTM describes longitudinal, dynamic patterns of medication adherence that may facilitate the development of targeted interventions to promote adherence. Implications for value-based payment systems are discussed in this review. DISCLOSURES No outside funding supported this study. The authors have no conflicts of interest to declare.
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Jackson EA, Ruppert K, Derby CA, Lian Y, Chae CU, Kazlauskaite R, Neal-Perry G, El Khoudary SR, Harlow SD, Solomon DH. Is race or ethnicity associated with under-utilization of statins among women in the United States: The study of women's health across the nation. Clin Cardiol 2020; 43:1388-1397. [PMID: 32862481 PMCID: PMC7724205 DOI: 10.1002/clc.23448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/14/2022] Open
Abstract
Background Rates of statin use among minority women are unclear. Hypothesis We hypothesized that statin use would vary by race/ethnicity with lower rates among minority women compared with Whites. Methods Data from the study of women's health across the nation, a multiethnic cohort of women collected between 2009 to 2011 were used to examine reported statin use by race/ethnicity and risk profile. Multivariable logistic modeling was performed to estimate the odds ratio (OR) of statin treatment. Results Of the 2399 women included, 234 had a diagnosis of atherosclerotic disease (ASCVD), 254 were diabetic (without ASCVD), 163 had an LDL ≥190 mg/dL, and 151 had a 10 year ASCVD pooled risk score ≥7.5%. Statins were used by 49.6% of women with CVD; 59.8% of women with diabetes without known ASCVD; 42.3% of women with an LDL ≥190 mg/dL; and 19.9% of women with an ASCVD risk ≥7.5%. Rates of statin use were 43.8% for women with ≥ two prior ASCVD events and 69.4% for women with ≥ one prior ASCVD event plus multiple high‐risk conditions. Among women eligible for statins, Black women had a significantly reduced adjusted odds of being on a statin (OR 0.53, 95% confidence interval [CI] 0.36‐0.78) compared with White women. Conclusions In this cohort of multiethnic women, rates of statin use among women who would benefit were low, with Black women having lower odds of statin use than White women.
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Affiliation(s)
- Elizabeth A Jackson
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kristine Ruppert
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carol A Derby
- The Saul R. Korey Department of Neurology, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Yinjuan Lian
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Claudia U Chae
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rasa Kazlauskaite
- Department of Medicine, Rush University Medical Center, chicago, Illinois, USA
| | - Genevieve Neal-Perry
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Samar R El Khoudary
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Siobán D Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel H Solomon
- Division of Rheumatology, Division of Pharmacoepidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Liu N, Mathews A, Swanson J, Mhaskar R, Mathews A, Ayoubi N, Mirza AS. Aspirin use for cardiovascular disease prevention in the uninsured population. SAGE Open Med 2020; 8:2050312120938224. [PMID: 32647578 PMCID: PMC7328214 DOI: 10.1177/2050312120938224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/04/2020] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Aspirin is an effective anti-inflammatory and antiplatelet agent as an irreversible inhibitor of cyclooxygenase. In 2016, the U.S. Preventive Services Task Force recommended aspirin for primary prevention of cardiovascular disease in patients aged 50-69 years with a 10% or greater 10-year cardiovascular disease risk. Current guidelines for patients with prior myocardial infarction or coronary artery disease recommend aspirin use for the secondary prevention of cardiovascular disease. Due to the lack of literature describing adherence to these recommendations in the uninsured patient population, we studied aspirin use for cardiovascular disease prevention in free medical clinics. METHODS We conducted a cross sectional study of uninsured patients who visited nine free medical clinics in 2016-2017. Data from the records of 8857 patients were combined into a database for analysis. 10-year Framingham risk scores for coronary artery disease were calculated for the 50-69-year-old population to evaluate which patients qualified for aspirin usage. Aspirin use was assessed for patients with prior myocardial infarction or coronary artery disease. RESULTS In total, 1443 patients met the criteria to take aspirin for primary prevention of cardiovascular disease, but just 17% of these patients aged 50-59 years were on the medication. About 15% of the patients aged 60-69 years were taking aspirin. Of the 297 patients who had prior myocardial infarction or coronary artery disease, 50% were taking aspirin for secondary prevention. CONCLUSION Among the uninsured population, there are low rates of aspirin use for risk reduction of cardiovascular disease. This study demonstrates that improvements are needed to increase adherence to current guidelines and address barriers uninsured patients may face in maintaining their cardiovascular health.
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Affiliation(s)
- Nina Liu
- Morsani College of Medicine, University
of South Florida, Tampa, FL, USA
| | - Adithya Mathews
- Department of Internal Medicine,
University of South Florida, Tampa, FL, USA
| | - Justin Swanson
- College of Public Health, University of
South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- Morsani College of Medicine, University
of South Florida, Tampa, FL, USA
| | - Akshay Mathews
- Honors College, University of South
Florida, Tampa, FL, USA
| | - Noura Ayoubi
- Morsani College of Medicine, University
of South Florida, Tampa, FL, USA
| | - Abu-Sayeef Mirza
- Department of Internal Medicine,
University of South Florida, Tampa, FL, USA
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24
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Nielsen SJ, Karlsson M, Björklund E, Martinsson A, Hansson EC, Malm CJ, Pivodic A, Jeppsson A. Socioeconomic Factors, Secondary Prevention Medication, and Long-Term Survival After Coronary Artery Bypass Grafting: A Population-Based Cohort Study From the SWEDEHEART Registry. J Am Heart Assoc 2020; 9:e015491. [PMID: 32114890 PMCID: PMC7335537 DOI: 10.1161/jaha.119.015491] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Low income and short education have been found to be independently associated with inferior survival after coronary artery bypass grafting (CABG), whereas the use of secondary prevention medications is associated with improved survival. We investigated whether underusage of secondary prevention medications contributes to the inferior long-term survival in CABG patients with a low income and short education. Methods and Results Patients who underwent CABG in Sweden between 2006 to 2015 and survived at least 6 months after discharge (n=28 448) were included in a population-based cohort study. Individual patient data from 5 national registries, including the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry, covering dispensing of secondary prevention medications (statins, platelet inhibitors, β-blockers, and RAAS inhibitors), socioeconomic factors, patient characteristics, comorbidity, and long-term mortaity were merged. All-cause mortality risk was estimated using multivariable Cox regression models adjusted for patient characteristics, baseline comorbidities, time-updated secondary prevention medications, and socioeconomic status. Long-term mortality was higher in patients with a low income and short education. Statins and platelet inhibitors were dispensed less often to patients with a low income, both at baseline and after 8 years. The decline in dispensing over time was steeper for low-income patients. Short education was not associated with reduced dispensing of any secondary prevention medication. Use of statins (adjusted hazard ratio=0.57 [95% CI, 0.53-0.61]), RAAS inhibitors (adjusted hazard ratio=0.78 [0.73-0.84]), and platelet inhibitors (adjusted hazard ratio=0.74 [0.68-0.80]) were associated with reduced long-term mortality irrespective of socioeconomic status. Conclusions Secondary prevention medications are dispensed less often after CABG to patients with low income. Underusage of secondary prevention medications after CABG is associated with increased mortality risk independently of income and extent of education.
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Affiliation(s)
- Susanne J Nielsen
- Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
| | - Martin Karlsson
- Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,Department of Medicine Skaraborg Hospital Lidköping Lidköping Sweden
| | - Erik Björklund
- Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,Department of Medicine South Älvsborg Hospital Borås Sweden
| | - Andreas Martinsson
- Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Emma C Hansson
- Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
| | - Carl Johan Malm
- Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
| | - Aldina Pivodic
- Statistiska Konsultgruppen Gothenburg Sweden.,Department of Ophthalmology Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine Sahlgrenska Academy Gothenburg University Gothenburg Sweden.,Department of Cardiothoracic Surgery Sahlgrenska University Hospital Gothenburg Sweden
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25
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Preoperative Statin Use and 90-Day Mortality after Noncardiac Surgery: A Hospital Registry Study. Ann Surg 2019; 274:e515-e521. [PMID: 31850989 DOI: 10.1097/sla.0000000000003737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the association between preadmission statin use and 90-day mortality after planned elective noncardiac surgery in adult patients. SUMMARY BACKGROUND DATA Statin therapy is known to have pleiotropic effects, which improve the outcomes of various diseases. However, the effect of perioperative statin therapy on postoperative mortality remains controversial. METHODS This retrospective cohort study analyzed the medical records of adult patients who were admitted to a single tertiary academic hospital for elective noncardiac surgery between January 2012 and December 2018. The primary endpoint was 90-day mortality, which was defined as any mortality within 90 days after surgery. The secondary endpoint was overall survival. RESULTS After propensity score matching, a total of 33,514 patients (16,757 patients in each group) were included in the analysis. The logistic regression analysis of the propensity score-matched cohort indicated that the odds ratio (OR) of 90-day mortality in the statin group was 26% lower than that of the nonstatin group [OR: 0.74; 95% confidence interval (CI): 0.59 to 0.92; P = 0.009]. The sensitivity analysis indicated that the high-dose intensity statin group had a 61% lower 90-day mortality rate than the nonstatin group (OR: 0.39; 95% CI: 0.18-0.84; P = 0.016). The overall survival time was significantly longer in the statin group than in the nonstatin group after propensity score matching (P < 0.001 by log-rank test). CONCLUSIONS Preoperative statin use was associated with lower 90-day mortality and longer overall survival for adult patients who underwent elective noncardiac surgery. This association was more evident for high-intensity statin users.
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26
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Olmastroni E, Boccalari MT, Tragni E, Rea F, Merlino L, Corrao G, Catapano AL, Casula M. Sex-differences in factors and outcomes associated with adherence to statin therapy in primary care: Need for customisation strategies. Pharmacol Res 2019; 155:104514. [PMID: 31678211 DOI: 10.1016/j.phrs.2019.104514] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 12/25/2022]
Abstract
Despite the invaluable efficacy of statins, adherence to therapy is extremely poor in clinical practice. Improvement interventions should be as personalized as possible, but it is necessary to know factors that most influence adherence, and sex seems to be a key determinant. Thus, we aimed at exploring potential areas of sex-differences in statin adherence in a real-world population. For this purpose, we assessed adherence (as proportion of days covered) on a wide cohort of new statin users aged >40 years, and we evaluated its association with several covariates through sex-stratified log-binomial regression models. In addition, to compare also the benefits of optimal statin adherence in primary prevention of cardiovascular disease between men and women, we implemented sex-stratified Cox proportional hazard models. Our study showed that women are more likely to stop or be less adherent to statin treatment than men. Moreover, we observed significant sex-differences on effect size of several factors associated with adherence that should be taken into consideration for the management of patients. Finally, we observed no significant difference between men and women regarding statin efficacy in terms of reduction of incident hospitalization for ischemic heart disease and/or non-haemorrhagic cerebrovascular disease. These results invoke the responsibility of physicians to a prompt and personalized intervention. Physicians should consider routine screening for non-adherence in their clinical practice, target patients at higher risk of non-adherence, and improved motivation and communication.
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Affiliation(s)
- Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.
| | - Mezio T Boccalari
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Elena Tragni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Federico Rea
- National Centre for Healthcare Research & Pharmacoepidemiology, Milan, Italy; Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Luca Merlino
- Epidemiologic Observatory, Lombardy Regional Health Service, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research & Pharmacoepidemiology, Milan, Italy; Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Alberico L Catapano
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto S. Giovanni (MI), Italy
| | - Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto S. Giovanni (MI), Italy
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27
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Ofori-Asenso R, Jakhu A, Curtis AJ, Zomer E, Gambhir M, Jaana Korhonen M, Nelson M, Tonkin A, Liew D, Zoungas S. A Systematic Review and Meta-analysis of the Factors Associated With Nonadherence and Discontinuation of Statins Among People Aged ≥65 Years. J Gerontol A Biol Sci Med Sci 2019; 73:798-805. [PMID: 29360935 DOI: 10.1093/gerona/glx256] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 01/01/2018] [Indexed: 02/02/2023] Open
Abstract
Background Older individuals (aged ≥65 years) are commonly prescribed statins but may experience a range of barriers in adhering to therapy. The factors associated with poor statin adherence and/or discontinuation among this population have not been comprehensively reviewed. Methods We conducted a systematic review to identify English articles published through December 12, 2016 that reported factors associated with nonadherence and/or discontinuation of statins among older persons. Data were pooled via random-effects meta-analysis techniques. Results Forty-five articles reporting data from more than 1.8 million older statin users from 13 countries were included. The factors associated with increased statin nonadherence were black/non-white race (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.39-1.98), female gender (OR 1.08, 95% CI 1.03-1.13), current smoker (OR 1.12, 95% CI 1.03-1.21), higher copayments (OR 1.38, 95% CI 1.25-1.52), new user (OR 1.58, 95% CI 1.21-2.07), lower number of concurrent cardiovascular medications (OR 1.08, 95% CI 1.06-1.09), primary prevention (OR 1.49, 95% CI 1.40-1.59), having respiratory disorders (OR 1.17, 95% CI 1.12-1.23) or depression (OR 1.11, 95% CI 1.06-1.16), and not having renal disease (OR 1.09, 95% CI 1.04-1.14). The factors associated with increased statin discontinuation were lower income status (OR 1.20, 95% CI 1.06-1.36), current smoker (OR 1.14, 95% CI 1.06-1.23), higher copayment (OR 1.61, 95% CI 1.53-1.70), higher number of medications (OR 1.04, 95% CI 1.01-1.06), presence of dementia (OR 1.18, 95% CI 1.02-1.36), cancer (OR 1.22, 95% CI 1.11-1.33) or respiratory disorders (OR 1.19, 95% CI 1.05-1.34), primary prevention (OR 1.66, 95% CI 1.24-2.22), and not having hypertension (OR 1.13, 95% CI 1.07-1.20) or diabetes (OR 1.09, 95% CI 1.04-1.15). Conclusion Interventions that target potentially modifiable factors including financial and social barriers, patients' perceptions about disease risk as well as polypharmacy may improve statin use in the older population.
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Affiliation(s)
- Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia.,Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Avtar Jakhu
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Andrea J Curtis
- STAREE, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Ella Zomer
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Manoj Gambhir
- Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Maarit Jaana Korhonen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, Melbourne, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Andrew Tonkin
- Cardiovascular Research Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Danny Liew
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Sophia Zoungas
- STAREE, Department of Epidemiology and Preventive Medicine, Melbourne, Australia.,Division of Metabolism, Genomics and Ageing, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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28
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Momo K, Yasu T, Yasui H, Kuroda SI. Risk factors affecting the failed low-density lipoprotein level achievement rate in working-age male population at high cardiovascular risk. J Clin Pharm Ther 2019; 44:715-719. [PMID: 31062402 DOI: 10.1111/jcpt.12847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/12/2019] [Accepted: 04/08/2019] [Indexed: 12/15/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The aim of this study was to clarify the low-density lipoprotein (LDL)-C level achievement rate and detect factors affecting the failed LDL-C achievement rate in patients treated with statins and anti-platelet agents using a large insurance claim database and health check-up data. METHODS Access to a large health insurance claims database, and health check-up data were obtained from Japan Medical Data Center (JMDC) Co. Ltd., Tokyo. The database was searched to identify employed working-age male patients who had started treatment with statin and anti-platelet drugs for the secondary prevention of cardiovascular events. These patients were enrolled in the retrospective cohort study, which included screening at 3 months and observation for 3 years. LDL-C levels were obtained from the annual health check-up data. The achievement rate for LDL-C < 100 was assessed for three consecutive years. Adherence was assessed using the proportion of days covered (PDC) for the statin, which was calculated from prescription data over a 3-year period. RESULTS AND DISCUSSION Overall, 294 patients (male/female, 294/0; age, 47.8 ± 6.0 years; body mass index, 24.8 ± 4.2 kg/m2 ; hypertension, 76.2%; and diabetes mellitus, 20.4%) were included. The LDL-C achievement rate for three consecutive years after starting treatment with statin and aspirin was 49.7%, 51.4% and 45.9%, respectively. Factors affecting failed LDL-C on adjusted odds were lower adherence to PDC [0.96 (0.94-0.99), P < 0.001, 1% increase] and higher baseline LDL-C [1.01 (1.00-1.02), P = 0.037, 1 mg/dL increase]. WHAT IS NEW AND CONCLUSION Our results suggest that in the working-age male population need to improve statin adherence, especially those with higher baseline LDL-C levels.
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Affiliation(s)
- Kenji Momo
- Department of Pharmacy, The Institute of Medical Science Hospital, The University of Tokyo, Tokyo, Japan.,Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Takeo Yasu
- Department of Pharmacy, The Institute of Medical Science Hospital, The University of Tokyo, Tokyo, Japan.,Department of Medicinal Therapy Research, Meiji Pharmaceutical University, Tokyo, Japan
| | - Hiroshi Yasui
- Department of Hematology/Oncology, The Institute of Medical Science Hospital, The University of Tokyo, Tokyo, Japan
| | - Sei-Ichiro Kuroda
- Department of Pharmacy, The Institute of Medical Science Hospital, The University of Tokyo, Tokyo, Japan
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29
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Chan PS, Spertus JA, Nallamothu BK. Making a Difference in Disparities. Circ Cardiovasc Qual Outcomes 2019; 10:CIRCOUTCOMES.117.004287. [PMID: 29017998 DOI: 10.1161/circoutcomes.117.004287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paul S Chan
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., J.A.S.); the University of Missouri-Kansas City (P.S.C., J.A.S.); the Department of Internal Medicine, Michigan Integrated Center for Health Analytics and Medical Prediction, University of Michigan, Ann Arbor (B.K.N.); and the Center for Clinical Management and Research, Ann Arbor VA Medical Center, MI (B.K.N.)
| | - John A Spertus
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., J.A.S.); the University of Missouri-Kansas City (P.S.C., J.A.S.); the Department of Internal Medicine, Michigan Integrated Center for Health Analytics and Medical Prediction, University of Michigan, Ann Arbor (B.K.N.); and the Center for Clinical Management and Research, Ann Arbor VA Medical Center, MI (B.K.N.)
| | - Brahmajee K Nallamothu
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (P.S.C., J.A.S.); the University of Missouri-Kansas City (P.S.C., J.A.S.); the Department of Internal Medicine, Michigan Integrated Center for Health Analytics and Medical Prediction, University of Michigan, Ann Arbor (B.K.N.); and the Center for Clinical Management and Research, Ann Arbor VA Medical Center, MI (B.K.N.).
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30
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Systematic review of the predictors of statin adherence for the primary prevention of cardiovascular disease. PLoS One 2019; 14:e0201196. [PMID: 30653535 PMCID: PMC6336256 DOI: 10.1371/journal.pone.0201196] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/21/2018] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Previous research has shown that statin adherence for the primary prevention of CVD is lower compared to secondary prevention populations. Therefore the aim of this systematic review was to review predictors of statin adherence for the primary prevention of CVD. METHODS A systematic search of papers published between Jan 1984 and May 2017 was conducted in PubMed, PsycINFO, EMbase and CINAHL databases. A study was eligible for inclusion if; 1) it was a study of the general population or of patients with familial hypercholesterolemia, hypertension, diabetes or arthritis; 2) statins were prescribed; 3) adherence was defined and measured as the extent to which patients followed their statin regimen during the period of prescription, and 4) it was an original trial or observational study (excluding case reports). A study was subsequently excluded if 1) results were not presented separately for primary prevention; 2) it was a trial of an intervention (for example patient education). Papers were reviewed by two researchers and consensus agreed with a third. A quality assessment (QA) tool was used to formally assess each included article. To evaluate the effect of predictors, data were quantitatively and qualitatively synthesised. RESULTS In total 19 studies met the inclusion criteria and nine were evaluated as high quality using the QA tool. The proportion of patients classed as "adherent" ranged from 17.8% to 79.2%. Potential predictors of statin adherence included traditional risk factors for CVD such as age, being male, diabetes and hypertension. Income associated with adherence more strongly in men than women, and highly educated men were more likely and highly educated women less likely to be adherent. Alcohol misuse and high BMI associated with non-adherence. There was no association between polypharmacy and statin adherence. The evidence base for the effect of other lifestyle factors and health beliefs on statin adherence was limited. CONCLUSION Current evidence suggests that patients with more traditional risk factors for CVD are more likely to be adherent to statins. The implications for future research are discussed.
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31
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Ofori-Asenso R, Zomer E, Curtis A, Tonkin A, Nelson M, Gambhir M, Liew D, Zoungas S. Patterns and Predictors of Adherence to Statin Therapy Among Older Patients: Protocol for a Systematic Review. JMIR Res Protoc 2017; 6:e39. [PMID: 28270383 PMCID: PMC5360893 DOI: 10.2196/resprot.7195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 12/14/2022] Open
Abstract
Background The benefits of statin therapy are significantly compromised by noncompliance. Although elderly patients may have particular challenges with medication adherence and persistence, previous reviews on statin adherence have not focused on this population. Additionally, comparisons of adherence and persistence specific to statin indication (primary or secondary prevention) have not been thoroughly explored. Objective We aim to assess the extent of, and factors associated with, adherence and persistence to statin therapy among older populations (aged ≥65 years). Methods A systematic review will be undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Searches will be performed using multiple electronic databases (Ovid MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and the National Health Service Economic Evaluation Database) to identify relevant randomized trials and observational studies that evaluated statin adherence and/or persistence as an outcome. Eligible studies will include those involving community-living or outpatient elderly individuals. The methodological quality of randomized controlled trials (RCTs) will be assessed via the Joanna Briggs Institute’s critical appraisal checklist for RCTs, and the quality assessment of observational studies will be undertaken using a set of questions formulated with resort to the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. When possible, meta-analyses will be conducted using random-effect modeling and generic inverse variance analyses for adjusted-effect estimates. Heterogeneity across studies will be quantified using the I2 statistic. The presence of publication bias will be assessed using funnel plots and Egger’s regression tests. A leave-one-out sensitivity analysis will also be conducted to assess the impact of individual study results on pooled estimates. To explore possible sources of heterogeneity across studies, subgroup analyses will be performed based on covariates such as study design, statin indication, country of study, and length of patient follow-up. Results The electronic database searches were completed in December 2016. Retrieved articles are currently being screened and the entire study is expected to be completed by June 2017. Conclusions This systematic review will provide further understanding of the patterns of, and barriers to, statin adherence and persistence among older patients. The findings will inform clinical practice and the design of appropriate interventions. Trial Registration PROSPERO CRD42016053191
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Affiliation(s)
- Richard Ofori-Asenso
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ella Zomer
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrea Curtis
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Tonkin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark Nelson
- Discipline of General Practice, University of Tasmania, Hobart, Australia
| | - Manoj Gambhir
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sophia Zoungas
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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