Preview

Rational Pharmacotherapy in Cardiology

Advanced search

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

https://doi.org/10.20996/1819-6446-2021-03-03

Full Text:

Abstract

Aim. To study medication adherence in elderly patients with coronary artery disease (CAD) in primary care practice.

Material and methods. The study conducted in out-patient clinic of Moscow city. 293 elderly (≥65 years) patients with established CAD included. The following patient data obtained via electronic medical record system: demography, medical history, modifiable risk factors and prescribed pharmacotherapy. Level of medication adherence measured by Morisky scale (MMAS-8) via telephone survey.

Results. According to Morisky scale high adherence was identified in 146 (49.8%) elderly patients, moderate adherence – in 99 (33.8%) patients, low adherence – in 48 (16.4%) patients. Analysis of specific questions of the scale done in non-adherent patients revealed signs of unintentional non-adherence due to forgetfulness (45.9%) and signs of intentional non-adherence due to patients feeling worse (35.8%) or better (28.4%). By means of dichotomic interpretation of Morisky scale results the population under research was divided into two groups: 147 (50.2%) non-adherent patients and 146 (49.8%) – totally adherent patients. These groups were comparable in terms of sex (female 71.2 vs 68.0%; p>0.05) and age (median 73.5 vs 73.0 years; p>0.05) distribution, and medical history: myocardial infarction (39.0% vs 38.8%), atrial fibrillation (37.0 and 41.5%), chronic heart failure (90.4% vs 91.2%), diabetes (26.7% vs 24.5%). There were fewer smokers in adherent group (0.7% vs 6.5%; p<0.05). As primary antianginal pharmacotherapy adherent and non-adherent patients were equally prescribed beta-blockers (75.3% vs 75.5%; p>0.05). Drugs that improve prognosis were also prescribed comparably: antiplatelets (66.4% vs 61.9%; p>0.05), anticoagulants (36.3% vs 44.9%; p>0.05), statins (82.2% vs 79.6%; p>0.05), renin-angiotensin system inhibitors (89.0 and 87.8%; p>0.05). Adherent patients had lower mean values of lipids: total cholesterol (4.7±1.2 vs 5.2±1.4 mmol/l; p<0.05) and low density cholesterol (2.4±0.9 vs 2.8±1.2 mmol/l; p<0.05). Non-adherent elderly patients made more visits to general practitioner (median 5 vs 3 visits; p<0.05). Share of patients receiving drugs within supplementary pharmaceutical provision program was comparable in both groups (53.7% vs 50.7%; p>0.05).

Conclusion. Half of elderly patients with CAD are non-adherent to treatment in primary care setting. Medical history and structure of pharmacotherapy do not influence level of adherence in this population. Among adherent patients fewer individuals smoke and mean values of lipids are lower. Non-adherent elderly patients cause higher load on general practitioner, supplementary pharmaceutical provision program provided no better adherence in the population under research.

About the Authors

S. K. Zyryanov
Peoples Friendship University of Russia (RUDN University)
Russian Federation

Sergey K. Zyryanov - eLibrary SPIN: 2725-9981.

Moscow



S. B. Fitilev
Peoples Friendship University of Russia (RUDN University)
Russian Federation

Sergey B. Fitilev – eLibrary SPIN: 8287-8456.

Moscow



A. V. Vozzhaev
Peoples Friendship University of Russia (RUDN University)
Russian Federation

Aleksandr V. Vozzhaev - eLibrary SPIN: 8637-8963.

Moscow



I. I. Shkrebneva
Peoples Friendship University of Russia (RUDN University)
Russian Federation

Irina I. Shkrebniova - eLibrary SPIN: 1105-5760.

Moscow



N. N. Shindryaeva
City polyclinic №2
Russian Federation

Natalia N. Shindryaeva -eLibrary SPIN: 1105-5760.

Moscow



D. A. Klyuev
Peoples Friendship University of Russia (RUDN University)
Russian Federation

Dmitry A. Kliuev - eLibrary SPIN: 8960-7798.

Moscow



L. N. Stepanyan
Peoples Friendship University of Russia (RUDN University)
Russian Federation

Liusine N. Stepanyan - eLibrary SPIN: 9275-2479.

Moscow



A. M. Lutsenko
Peoples Friendship University of Russia (RUDN University)
Russian Federation

Artem M. Lutsenko - eLibrary SPIN: 6680-2398.

Moscow



A. T. Tsai
Peoples Friendship University of Russia (RUDN University)
Russian Federation

Aleksandra T. Tsay - eLibrary SPIN: 7456-5859.

Moscow



A. A. Danilova
Peoples Friendship University of Russia (RUDN University)
Russian Federation

Arina A. Danilova - eLibrary SPIN: 5526-1622.

Moscow



References

1. Roth GA, Johnson C, Abajobir A, et al. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J Am Coll Cardiol. 2017;70(1):1-25. DOI:10.1016/j.jacc.2017.04.052.

2. Moran AE, Forouzanfar MH, Roth GA, et al. Temporal trends in ischemic heart disease mortality in 21 world regions, 1980 to 2010: the Global Burden of Disease 2010 study. Circulation. 2014;129(14):1483-92. DOI:10.1161/CIRCULATIONAHA.113.004042.

3. Tkacheva ON, Belenkov YN, Karpov YA, Zyryanov SK. Gerontology Issues in Cardiology Practice. Kardiologiia. 2019;59(12):54-63 (In Russ.) DOI:10.18087/cardio.2019.12.n876.

4. Tkacheva ON, Kotovskaya YuV, Duplyakov DV. Problems of providing cardiac care for later-life patients: status and prospects. Part 1. Ischemic heart disease. Kardiologiia. 2017;3(14):15-21 (In Russ.) DOI:10.24411/2309-1908-2017-00001.

5. Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-77. DOI:10.1093/eurheartj/ehz425.

6. Chaudri NA. Adherence to Long-term Therapies Evidence for Action. Ann Saudi Med. 2004;24(3):221-2. DOI:10.5144/0256-4947.2004.221.

7. Chowdhury R, Khan H, Heydon E, et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J. 2013;34(38):2940-8. DOI:10.1093/eurheartj/eht295.

8. Demonceau J, Ruppar T, Kristanto P, et al. Identification and assessment of adherence-enhancing interventions in studies assessing medication adherence through electronically compiled drug dosing histories: a systematic literature review and meta-analysis. Drugs. 2013;73(6):545-62. DOI:10.1007/s40265-013-0041-3.

9. Chen HY, Saczynski JS, Lapane KL, et al. Adherence to evidence-based secondary prevention pharmacotherapy in patients after an acute coronary syndrome: A systematic review. Heart Lung. 2015;44(4):299-308. DOI:10.1016/j.hrtlng.2015.02.004.

10. George J, Elliott RA, Stewart DC. A systematic review of interventions to improve medication taking in elderly patients prescribed multiple medications. Drugs Aging. 2008;25(4):307-24. DOI:10.2165/00002512-200825040-00004.

11. Topinkova E, Baeyens JP, Michel JP, Lang PO. Evidence-based strategies for the optimization of pharmacotherapy in older people. Drugs Aging. 2012;29(6):477-94. DOI:10.2165/11632400-000000000-00000.

12. Gellad WF, Grenard JL, Marcum ZA. A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity. Am J Geriatr Pharmacother. 2011;9(1):11-23. DOI:10.1016/j.amjopharm.2011.02.004.

13. Balkrishnan R. Predictors of medication adherence in the elderly. Clin Ther. 1998;20(4):764-71. DOI:10.1016/s0149-2918(98)80139-2.

14. Lenzi J, Rucci P, Castaldini I, et al. Does age modify the relationship between adherence to secondary prevention medications and mortality after acute myocardial infarction? A nested case-control study. Eur J Clin Pharmacol. 2015;71(2):243-50. DOI:10.1007/s00228-014-1793-8.

15. Zullig LL, Ramos K, Bosworth HB. Improving Medication Adherence in Coronary Heart Disease. Curr Cardiol Rep. 2017;19(11):113. DOI:10.1007/s11886-017-0918-y.

16. Du L, Cheng Z, Zhang Y, et al. The impact of medication adherence on clinical outcomes of coronary artery disease: A meta-analysis. Eur J Prev Cardiol. 2017;24(9):962-70. DOI:10.1177/2047487317695628.

17. Bochkareva EV, Butina EK, Kim IV, et al. Adherence to antihypertensive medication in Russia: a scoping review of studies on levels, determinants and intervention strategies published between 2000 and 2017. Arch Public Health. 2019;77(1):43. DOI:10.1186/s13690-019-0366-9.

18. Tkacheva ON, Kotovskaja JuV, Runihina NK, et al. Pharmacotherapy in the elderly and senile age. Moscow: Prometej; 2019 (In Russ.)

19. Bojcov SA, Pogosova NV, Bubnova MG, et al. Cardiovascular prevention 2017. National guidelines. Russian Journal of Cardiology. 2018;(6):7-122 (In Russ.) DOI:10.15829/1560-4071-2018-6-7-122.

20. Oganov RG, Simanenkov VI, Bakulin IG, et al. Comorbidities in clinical practice. Algorithms for diagnostics and treatment. Cardiovascular Therapy and Prevention. 2019;18(1):5-66 (In Russ.) DOI:10.15829/1728-8800-2019-1-5-66.

21. Orimo H. Reviewing the definition of elderly. Nihon Ronen Igakkai Zasshi. 2006;43(1):27-34. DOI:10.3143/geriatrics.43.27.

22. Nguyen TM, La Caze A, Cottrell N. What are validated self-report adherence scales really measuring?: a systematic review. Br J Clin Pharmacol. 2014;77(3):427-45. DOI:10.1111/bcp.12194.

23. Culig J, Leppée M. From Morisky to Hill-bone; self-reports scales for measuring adherence to medication. Coll Antropol. 2014;38(1):55-62.

24. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74. DOI:10.1097/00005650-198601000-00007.

25. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348-54. DOI:10.1111/j.1751-7176.2008.07572.x.

26. Lukina YV, Martsevich SY, Kutishenko NP. The Moriscos-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.

27. Tan X, Patel I, Chang J, et al. Review of the four item Morisky Medication Adherence Scale (MMAS-4) and eight item Morisky Medication Adherence Scale (MMAS-8). Innov Pharm. 2014;5(165):1-8.

28. Lukina YV, Dmitrieva NA, Kutishenko NP, et al. The relationship and interinfluence of aspects of therapy safety and compliance in patients with cardiovascular diseases (by the data from outpatient registry “PROFILE”). Cardiovascular Therapy and Prevention. 2018;17(5):72-8 (In Russ.) DOI:10.15829/1728-8800-2018-5-72-78.

29. Fofanova TV, Ageev FT, Smirnova MD, Deev AD. Adherence to Therapy in the Outpatient Setting: the Ability to Identify and Assess the Effectiveness of Therapy. Kardiologiia. 2017;57(7):35-42 (In Russ.) DOI:10.18087/cardio.2017.7.10004.

30. Warren JR, Falster MO, Fox D, Jorm L. Factors influencing adherence in long-term use of statins. Pharmacoepidemiol Drug Saf. 2013;22(12):1298-307. DOI:10.1002/pds.3526.

31. Lukina YV, Kutishenko NP, Martsevich SY. Treatment adherence: modern view on a well known issue. Cardiovascular Therapy and Prevention. 2017;16(1):91-5 (In Russ.) DOI:10.15829/1728-8800- 2017-1-91-95.

32. Feinstein AR. On white-coat effects and the electronic monitoring of compliance. Arch Intern Med. 1990;150(7):1377-8.


For citation:


Zyryanov S.K., Fitilev S.B., Vozzhaev A.V., Shkrebneva I.I., Shindryaeva N.N., Klyuev D.A., Stepanyan L.N., Lutsenko A.M., Tsai A.T., Danilova A.A. Adherence to Medical Treatment in Elderly Patients with Coronary Artery Disease in the Settings of Primary Outpatient Care. Rational Pharmacotherapy in Cardiology. 2021;17(2):178-185. https://doi.org/10.20996/1819-6446-2021-03-03

Views: 403


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


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