Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Adherence to Statins Therapy of High and Very High Cardiovascular Risk Patients in Real Clinical Practice: Diagnostics and Possible Ways to Solve the Problem (According to the PRIORITY Observational Study)

https://doi.org/10.20996/1819-6446-2018-14-6-891-900

Full Text:

Abstract

Aim. To study adherence to treatment with generic statins prescribed to patients with high and very high cardiovascular risk in routine clinical practice, as well as the possible impact of educational training of doctors on compliance with clinical guidelines and changes in patient adherence to treatment. Material and methods. The study was prospective, with educational training for physicians on the main provisions of current clinical guidelines prior to the program. It included 3 visits over 12 weeks: inclusion visit (V0), and visits after 1 and 3 months of follow-up (V1 and V3). The use of generic atorvastatin or rosuvastatin was recommended for all patients. To assess adherence the following surveys were used: medical survey (all visits), the original questionnaire to assess the potential and the actual commitment to taking statins and the causes of non-adherence, and the Morisky-Green 8-question test (visits V0 and V3) to evaluate overall adherence to drug treatment. The patients who started the drug taking according to the medical recommendations and continued it during the study were considered as adherents. Patients who started but stopped taking the drug for 12 weeks were considered as partially non-adherent. Patients who refused to take the recommended statin were considered as non-adherents. The prescribed doses of statins and medical tactics in the titration of doses, as well as the achievement of the target level of low-density lipoprotein cholesterol (LDL cholesterol) were evaluated. Results. 112 (37.5%) of the 298 patients with baseline indications for taking statins did not take these drugs. According to the medical survey at V0 a total of 286 (96%) patients were potential adherents to medical recommendations; at V3 262 (88%) patients were adherent to statin treatment; 34 patients were partially non-adherent, 1 – was non-adherent, and 1 – dropped out of the study immediately after V0. According to the original questionnaire, potential adherence was assessed in 281 patients: 244 (86.8%) were potentially adherent, 37 (13.2%) – partially non-adherent. At V3, out of 294 patients who filled in the original questionnaire, 260 (88.5%) were adherent, 26 (8.8%) – partly non-adherent, 8 (2.7%) – nonadherent. The Morisky-Green questionnaire was filled in by 292 patients: at V0, 106 patients (36.3%) had treatment adherence, non-adherence – 186 patients (63.7%). By V3, an increase in total adherence was found: 159 patients (54.5%) were adherent, and 133 (45.5%) – non-adherent. The lipid profile was evaluated in 231 patients in V1 and in 285 ones – in V3. The target LDL cholesterol level was reached by V1 in 47 (20.3%) patients, and in 184 (79.7%) patients – was not. Dose titration occurred in 56 patients. By V3, 121 (42.4%) patients reached the target level of LDL cholesterol, and 164 – did not. The results of the lipid profile analysis were erroneously interpreted in 21 patients. Conclusion The results of the medical survey and the original questionnaire for assessing adherence predominantly coincided. The Morisky-Green test does not accurately reflect patients' commitment to taking a particular drug. Clinical inertness of doctors in the titration of statin doses and achievement of target LDL cholesterol levels were found as well as erroneous interpretation of the LDL cholesterol level. Educational trainings for doctors had a positive effect on the implementation of clinical guidelines, and also contributed to increasing patient adherence to medical recommendations.

About the Authors

S. Yu. Martsevich
National Medical Research Center for Preventive Medicine
Russian Federation
MD, PhD, Professor, Head of Department of Preventive Pharmacotherapy


Yu. V. Lukina
National Medical Research Center for Preventive Medicine
Russian Federation
MD, PhD, Leading Researcher, Laboratory of Pharmacoepidemiological Studies, Department of Preventive Pharmacotherapy


N. P. Kutishenko
National Medical Research Center for Preventive Medicine
Russian Federation
MD, PhD, Head of Laboratory of Pharmacoepidemiological Studies, Department of Preventive Pharmacotherapy


N. A. Dmitrieva
National Medical Research Center for Preventive Medicine
Russian Federation
MD, PhD, Senior Researcher, Laboratory of Pharmacoepidemiological Studies, Department of Preventive Pharmacotherapy


S. V. Blagodatskikh
National Medical Research Center for Preventive Medicine
Russian Federation
PhD (Chemistry), Senior Researcher, Department of Preventive Pharmacotherapy


O. V. Lerman
National Medical Research Center for Preventive Medicine
Russian Federation
MD, PhD, Senior Researcher, Department of Preventive Pharmacotherapy


T. A. Gomova
Tula Regional Clinical Hospital
Russian Federation
MD, PhD, Deputy Chief Medical Officer for General Issues


S. I. Drozdetsky
Volga Research Medical University
Russian Federation
MD, PhD, Professor, Chair of Faculty and Polyclinic Therapy


V. V. Skibitskiy
Kuban State Medical University
Russian Federation
MD, PhD, Professor, Head of Chair of Hospital Therapy


E. A. Kudryashov
Kuban State Medical University
Russian Federation
MD, PhD, Associate Professor, Chair of Hospital Therapy


N. F. Puchinyan
Saratov State Medical University named after V.I. Razumovsky
Russian Federation
MD, PhD, Researcher, Department of Atherosclerosis


References

1. Catapano A.L., Graham I., De Backer G. et al. 2016 ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J. 2016;37(39):2999-3058. doi:10.1093/eurheartj/ehw272.

2. Ezhov M.V., Sergienko I.V., Aronov D.M., et al. Diagnosis and correction of lipid metabolism disorders for the prevention and treatment of atherosclerosis. Russian recommendations VI revision. Atherosclerosis and Dyslipidemia. 2017;1:5-22 (In Russ.)

3. Suvorov A.Y., Martsevich S.Y., Kutishenko N.P., et al. Evaluation of the conformity of cardiovascular therapy to current clinical guidelines in the improvement of outcomes in patients after stroke (according to the LIS-2 register). Rational Pharmacotherapy in Cardiology. 2015;11(3):247-52. (In Russ.) doi:10.20996/1819-6446-2015-11-3-247-252.

4. Malay L.N., Martsevich S.Y., Solokhina L.V., et al. Evaluation of treatment of patients with acute myocardial infarction before reference event and before discharge from the hospital: register data (Khabarovsk city). Part 2. Rational Pharmacotherapy in Cardiology. 2017;13(1):55-62. (In Russ.) doi:10.20996/1819-6446-2017-13-1-55-62.

5. Kutishenko N.P., Kalaydzhyan E.P., Sichinava D.P., et al. Outpatient registry of patients with acute myocardial infarction (PROFILE-IM): data on prehospital therapy in comparison with the LIS-3 registry. Rational Pharmacotherapy in Cardiology. 2018;14(1):88-93. (In Russ.) doi:10.20996/1819-6446-2018-14-1-88-93.

6. Ershova A.I., Meshkov A.N., Yakushin S.S. et al. Diagnosis and treatment of patients with severe hypercholesterolemia in real outpatient practice (according to the RECVASA registry). Rational Pharmacotherapy in Cardiology. 2014;10(6):612-6. (In Russ.) doi:10.20996/1819-6446-2014-10-6-612-616.

7. Martsevich S.Y., Gaisenok O.V., Tripkosh S.G., et al. Real practice of statins use and its dependence on follow-up in the specialized medical centre in patients with high cardiovascular risk (according to the PROFILE register). Rational Pharmacotherapy in Cardiology. 2013;9(4):362-7. (In Russ.) doi:10.20996/1819-6446-2013-9-4-362-367.

8. Tolpygina S.N., Polyanskaya Y.N., Martsevich S.Y. Hypolipidemic therapy in patients with chronic ischemic heart disease in 2004-2010 according to the PROGNOZ IBS register. Rational Pharmacotherapy in Cardiology. 2015;11(2):153-8. (In Russ.) doi:10.20996/1819-6446-2015-11-2-153-158.

9. Diagnosis and correction of lipid metabolism disorders for the prevention and treatment of atherosclerosis. Russian recommendations, V revision [cited by Nov 10, 2018]. Available from: http://www.scardio.ru/content/Guidelines/rek_lipid_2012.pdf. (In Russ.)

10. Morisky D.E., Ang A., Krousel-Wood M., Ward H.J. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348-54.

11. Lukina Y.V., Martsevich S.Y., Kutishenko N.P. The Moriskcos-Green scale: the pros and cons of universal test, correction of mistakes. Rational Pharmacotherapy in Cardiology. 2016;12(1):63-5. (In Russ.) doi:10.20996/1819-6446-2016-12-1-63-65.

12. Lam W.Y., Fresco P. Medication Adherence Measures: An Overview. Biomed Res Int. 2015; 2015:217047. doi:10.1155/2015/217047.

13. Porteous T., Francis J., Bond C., Hannaford P. Temporal stability of beliefs about medicines: implications for optimizing adherence. Patient Educ Couns. 2010;79(2):225-30. doi:10.1016/j.pec.2009.07.037.

14. Gomez Sandoval Y.H., Braganza M.V., Daskalopoulou S.S. Statin discontinuation in high-risk patients: a systematic review of the evidence. J Clin Lipidol. 2016; 10(4): 987-995. doi:10.1016/j.jacl.2016.04.010.

15. Semenova Y.V., Kutishenko N.P., Zagebelnyy A.V., et al. Adherence to attendance at outpatient clinic, quality of prehospital therapy, and direct outcome of acute coronary syndrome: analysis within LIS-3 registry. Rational Pharmacotherapy in Cardiology. 2016;12(4):430-4. (In Russ.) doi:10.20996/1819-6446-2016-12-4-430-434.

16. Hamilton W., Round A., Sharp D. Patient, hospital, and general practitioner characteristics associated with non-attendance: A cohort study. British Journal of General Practice. 2002; 477 (52): 317-9.

17. Lukina Yu.V., Kutishenko N.P., Dmitrieva N.A., Martsevich S.Yu. Adherence of patients with chronic ischemic heart disease to medical recommendations (according to the data of the out-patient register PROFILE. Russian Cardiological Journal. 2017;2(142):14-9 (In Russ.) doi:10.15829/1560-4071-2017-3-14-19.

18. Zhuravskaya N.Yu., Kutishenko N.P., Martsevich S.Yu., et al. Study of adherence to the medical recommendations of patients who have had a stroke. The role of anxiety and depression (results of the register LIS-2). Cardiovascular Therapy and Prevention. 2015;14(2):46-51 (In Russ.) doi:10.15829/1728-8800-2015-2-46-51.


For citation:


Martsevich S.Y., Lukina Y.V., Kutishenko N.P., Dmitrieva N.A., Blagodatskikh S.V., Lerman O.V., Gomova T.A., Drozdetsky S.I., Skibitskiy V.V., Kudryashov E.A., Puchinyan N.F. Adherence to Statins Therapy of High and Very High Cardiovascular Risk Patients in Real Clinical Practice: Diagnostics and Possible Ways to Solve the Problem (According to the PRIORITY Observational Study). Rational Pharmacotherapy in Cardiology. 2018;14(6):891-900. https://doi.org/10.20996/1819-6446-2018-14-6-891-900

Views: 134


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)