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Camila de Souza Groia Veloso R, Cruzeiro MGM, Dias BM, Reis AMM. Assessment of adherence to statin therapy in patients with coronary artery disease: comparison of three self-reporting measures. Eur J Hosp Pharm 2023; 30:24-28. [PMID: 34031152 PMCID: PMC9811568 DOI: 10.1136/ejhpharm-2021-002725] [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: 02/05/2021] [Revised: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To investigate adherence to statin therapy using three self-reporting adherence measures in patients with coronary artery disease and to compare the three measures. METHODS A cross-sectional study was carried out at a multidisciplinary outpatient clinic of cardiology at a teaching hospital in south-eastern Brazil in patients with coronary artery disease who were using statins. The sample consisted of 148 patients who were selected from April 2018 to February 2019. Adherence to statin therapy was determined by the Measure of Adherence to Treatment, Visual Analogue Scale of adherence and 7-day recall. A descriptive analysis and determination of the level of agreement between the adherence scales by the Cohen kappa coefficient were performed. RESULTS The study included 148 patients (104 (70.3%) men, median age 62 years) diagnosed with coronary artery disease who were using statins. The adherence to statin therapy was 98.6% using the Measure of Adherence to Treatment, 95.9% with the Visual Analogue Scale and 95.3% with 7-day recall. Agreement between the Measure of Adherence to Treatment and the Visual Analogue Scale (0.277) and the Measure of Adherence to Treatment and 7-day recall (0.241) was low. There was a high level of agreement between the Visual Analogue Scale and 7-day recall (0.759). CONCLUSIONS The adherence Visual Analogue Scale and 7-day recall were shown to be easy to apply, low-cost adherence measures to identify adherence to statins in patients with coronary artery disease. The Measure of Adherence to Treatment may also be used to provide information regarding the specific reasons for non-adherent behaviour.
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Affiliation(s)
- Ronara Camila de Souza Groia Veloso
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Bianca Menezes Dias
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Adriano Max Moreira Reis
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Yu M, Wang L, Guan L, Qian M, Lv J, Deng M. Knowledge, attitudes, and barriers related to medication adherence of older patients with coronary heart disease in China. Geriatr Nurs 2021; 43:235-241. [PMID: 34952306 DOI: 10.1016/j.gerinurse.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To investigate the knowledge, attitudes, and barriers related to medication adherence in older patients with coronary heart disease (CHD). METHODS A total of 272 older patients with CHD were investigated by the Chinese version of the Medication Adherence Scale. The score ranges for the knowledge, attitudes, and barrier subscales were 0-30, 0-30, and 0-110, respectively. Higher scores indicate more knowledge, positive attitudes, and more barriers related to medication adherence. RESULTS The median scores of knowledge, attitudes and barriers were 25.5, 28, and 8, respectively. Having stents, living alone, good financial status and fewer chronic diseases were related to more knowledge. Younger age, having no stent, and more chronic diseases were associated with more barriers. Patients with good financial status and higher age had more positive attitudes. CONCLUSIONS Understanding older patients' knowledge, attitudes, and barriers related to medication adherence and their associated factors can help develop tailored interventions in medication adherence studies.
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Affiliation(s)
- Mingming Yu
- School of Nursing, Peking University, Beijing, China.
| | - Li Wang
- Nursing Department, Fangzhuang Community Healthcare Service Center, Fengtai District, Beijing, China
| | - Lanzhu Guan
- Nursing Department, Anzhen Community Healthcare Service Center, Chaoyang District, Beijing, China
| | - Min Qian
- School of Nursing, Peking University, Beijing, China
| | - Jinghong Lv
- School of Nursing, Peking University, Beijing, China
| | - Mengying Deng
- School of Nursing, Peking University, Beijing, China
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Fang HSA, Gao Q, Lee ML, Hsu W, Tan NC. LDL-cholesterol change and goal attainment following statin intensity titration among Asians in primary care: a retrospective cohort study. Lipids Health Dis 2021; 20:2. [PMID: 33407522 PMCID: PMC7788928 DOI: 10.1186/s12944-020-01427-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/07/2020] [Indexed: 12/18/2022] Open
Abstract
Background Clinical trials have demonstrated that either initiating or up-titrating a statin dose substantially reduce Low-Density Lipoprotein-Cholesterol (LDL-C) levels. However, statin adherence in actual practice tends to be suboptimal, leading to diminished effectiveness. This study aims to use real-world data to determine the effect on LDL-C levels and LDL-C goal attainment rates, when selected statins are titrated in Asian patients. Methods A retrospective cohort study over a 5-year period, from April 2014 to March 2019 was conducted on a cohort of multi-ethnic adult Asian patients with clinical diagnosis of Dyslipidaemia in a primary care clinic in Singapore. The statins were classified into low-intensity (LI), moderate-intensity (MI) and high-intensity (HI) groups according to the 2018 American College of Cardiology and American Heart Association (ACC/AHA) Blood Cholesterol Guidelines. Patients were grouped into “No statin”, “Non-titrators” and “Titrators” cohorts based on prescribing patterns. For the “Titrators” cohort, the mean percentage change in LDL-C and absolute change in LDL-C goal attainment rates were computed for each permutation of statin intensity titration. Results Among the cohort of 11,499 patients, with a total of 266,762 visits, there were 1962 pairs of LDL-C values associated with a statin titration. Initiation of LI, MI and HI statin resulted in a lowering of LDL-C by 21.6% (95%CI = 18.9–24.3%), 28.9% (95%CI = 25.0–32.7%) and 25.2% (95%CI = 12.8–37.7%) respectively. These were comparatively lower than results from clinical trials (30 to 63%). The change of LDL-C levels due to up-titration, down-titration, and discontinuation were − 12.4% to − 28.9%, + 13.2% to + 24.6%, and + 18.1% to + 32.1% respectively. The improvement in LDL-C goal attainment ranged from 26.5% to 47.1% when statin intensity was up-titrated. Conclusion In this study based on real-world data of Asian patients in primary care, it was shown that although statin titration substantially affected LDL-C levels and LDL-C goal attainment rates, the magnitude was lower than results reported from clinical trials. These results should be taken into consideration and provide further insight to clinicians when making statin adjustment recommendations in order to achieve LDL-C targets in clinical practice, particularly for Asian populations.
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Affiliation(s)
- Hao Sen Andrew Fang
- SingHealth Polyclinics, SingHealth, 167, Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore, P.O. 150167, Singapore.
| | - Qiao Gao
- Institute of Data Science, National University of Singapore, Singapore, Singapore
| | - Mong Li Lee
- School of Computing, National University of Singapore, Singapore, Singapore.,Institute of Data Science, National University of Singapore, Singapore, Singapore
| | - Wynne Hsu
- School of Computing, National University of Singapore, Singapore, Singapore.,Institute of Data Science, National University of Singapore, Singapore, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, SingHealth, 167, Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore, P.O. 150167, Singapore.,Family Medicine Academic Clinical Programme, SingHealth-Duke NUS Academic Medical Centre, Singapore, Singapore
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Podzolkov VI, Bragina AE, Vasil’eva LV, Grintsevich YP, Rodionova YN. Adherence to statin therapy in patients with high and very high cardiovascular risk in real clinical practice. SECHENOV MEDICAL JOURNAL 2020. [DOI: 10.47093/2218-7332.2020.11.1.38-48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite the proven efficacy of lipid-lowering therapy, adherence to long-term statin therapy in patients with cardiovascular disease remains low.Aim. To study adherence to long-term statin therapy and factors associated with adherence in patients with high and very high cardiovascular risk (CVR) in real clinical practice.Materials and methods. The single-center cohort study included 53 patients (mean age 68.1 ± 10.2 years) with high or very high CVR on the SCORE scale and have been taking statins for at least 3 months prior to inclusion in the study. The level of low-density lipoprotein cholesterol (LDL-C), cognitive impairment (MoCA test), anxiety and depression (HADS scale), presence of senile asthenia (FRAIL scale), M. Charlson comorbidity index were assessed. Adherence to statin therapy was assessed using the original questionnaire. The correlation between patient adherence and ordinal variables for the scores of the studied scales was studied.Results. Completely adherent to statin therapy were only 12 (22%) patients, 14 (26%) were insufficiently adherent, 27 (51%) were non-adherent. The target level of LDL-С was achieved in 13 (25%) patients. 38 (72%) patients showed a decrease in cognitive functions; a positive correlation was found between adherence and the MoCA test (r = 0.44, p = 0.04). Clinical and subclinical depression and anxiety were noted in 12 (23%) and 14 (26%) patients, respectively. A statistically significant negative correlation was found between adherence and depression (r = –0.32; p = 0.04) and a positive correlation between adherence and anxiety (r = 0.44; p = 0.04). There was no statistically significant correlation between adherence and the FRAIL fragility scale, as well as the M. Charlson comorbidity index.Conclusions. Depression and cognitive decline are associated with decreased adherence to statin therapy.
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Affiliation(s)
- V. I. Podzolkov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - A. E. Bragina
- Sechenov First Moscow State Medical University (Sechenov University)
| | - L. V. Vasil’eva
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | - Yu. N. Rodionova
- Sechenov First Moscow State Medical University (Sechenov University)
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Klimis H, Chow CK. Clinical consequences of poor adherence to lipid-lowering therapy in patients with cardiovascular disease: can we do better? HEART ASIA 2019; 11:e011200. [PMID: 31566625 PMCID: PMC6743445 DOI: 10.1136/heartasia-2019-011200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Harry Klimis
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Clara K Chow
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
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Wu Q, Zhang D, Zhao Q, Liu L, He Z, Chen Y, Huang H, Hou Y, Yang X, Gu J. Effects of transitional health management on adherence and prognosis in elderly patients with acute myocardial infarction in percutaneous coronary intervention: A cluster randomized controlled trial. PLoS One 2019; 14:e0217535. [PMID: 31150451 PMCID: PMC6544260 DOI: 10.1371/journal.pone.0217535] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 05/14/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose This study aimed to assess the effects of transitional health management on adherence and prognosis in elderly patients with acute myocardial infarction undergoing percutaneous coronary intervention. Methods We conducted the trial from June 2016 to December 2016. A total of one hundred and fifty patients with acute myocardial infarction after PCI who met the inclusion criteria were randomly divided into an experimental (n = 75) group and a control (n = 75) group. The participants in the experimental group received transitional health management for three months. The two groups of patients were evaluated for treatment adherence, quality of life, clinical indicators, adverse cardiovascular events and statistics regarding readmission rates at baseline and 6 months after discharge. Results Compared with the controls, patients in the intervention group demonstrated better medication adherence, reexamination adherence, healthy lifestyle and clinical indicators (all P<0.05) and lower rates of adverse cardiovascular events and readmission (all P<0.05). Conclusion Transitional health management effectively improved adherence in elderly patients with acute myocardial infarction after PCI, ameliorated clinical indicators, and effectively reduced the incidence of adverse cardiovascular events and readmission rates. Transitional health management was an effective intervention for PCI patients after discharge.
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Affiliation(s)
- Qing Wu
- Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dandan Zhang
- Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qi Zhao
- Department of Radiotherapy, The First Affiliated Hospital of Soochow University, Suzhou, China
- * E-mail:
| | - Lin Liu
- Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhisong He
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Chen
- Nursing Department, the 2 Affiliated Hospital of Soochow University, Suzhou, China
| | - Hui Huang
- Nursing Department, the 2 Affiliated Hospital of Soochow University, Suzhou, China
| | - Yunyin Hou
- Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaofang Yang
- Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jie Gu
- Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, China
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