open access
Implementation of therapeutic recommendations in high cardiovascular-risk patients. The Polish population of EUROASPIRE V survey
, 2, 2, 1, 2, 3, 4, 5, 6, 7, 8, 2
Affiliations- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Family Medicine, Nicolaus Copernicus University, Torun, Poland
- Department of Epidemiology and Health Promotion, School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
- Department of Cardiology and Hypertension with Electrophysiological Lab, Central Research Hospital the Ministry of the Interior and Administration, Warszawa, Poland
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Poland
open access
Abstract
Introduction: Poor medication adherence is associated with unsatisfactory health outcomes, elevated mortality, and high costs of medical care. This study aimed to assess the implementation of therapeutic recommendations in high cardiovascular-risk patients based on self-report questionnaires.
Material and methods: The study included 194 patients from the Cardiology Outpatient Clinic. Two self-reported questionnaires were used to assess medication adherence: the Medication Adherence Questionnaire (MAQ) and the Adherence in Chronic Diseases Scale (ACDS).
Results: Antihypertensive drugs were prescribed to 65.46% of the patients. According to the MAQ, 54.33% of them reported high adherence, 21.26% medium adherence, and 24.41% low adherence to the treatment. Lipid-lowering drugs were prescribed to 46.39% of the patients, all of whom were treated with statins. Among this group, 34.44% reported high adherence, 27.78% medium adherence, and 37.78% low adherence to pharmacotherapy. According to the ACDS, the majority of patients (45.55%) received a score indicating medium adherence (21–26 points), 39.27% high adherence ( > 26 points), and 16.75% low adherence to treatment ( < 21 points). A high level of adherence was declared by 61.54% of the patients that reached the therapeutic goal of lipid-lowering therapy, defined as LDL-C of < 2.6 mmol/L ( < 100 mg/dL). On the other hand, among the patients whose LDL-C remained elevated, 23.44% declared high adherence to treatment. There were no significant differences in achieving the intended therapeutic goal of blood pressure (BP ≤ 140/90 mmHg) in the groups with high, medium and low adherence (26.53% vs. 23.47% vs. 50.00%; p = 0.1880).
Conclusion: Despite higher adherence to treatment in the patients with hypertension compared to patients with hyperlipidemia, the latter more often achieved the therapeutic goal. Declarations regarding high adherence to medication in the MAQ and in the ACDS are consistent in patients with hyperlipidemia and hypertension.
Abstract
Introduction: Poor medication adherence is associated with unsatisfactory health outcomes, elevated mortality, and high costs of medical care. This study aimed to assess the implementation of therapeutic recommendations in high cardiovascular-risk patients based on self-report questionnaires.
Material and methods: The study included 194 patients from the Cardiology Outpatient Clinic. Two self-reported questionnaires were used to assess medication adherence: the Medication Adherence Questionnaire (MAQ) and the Adherence in Chronic Diseases Scale (ACDS).
Results: Antihypertensive drugs were prescribed to 65.46% of the patients. According to the MAQ, 54.33% of them reported high adherence, 21.26% medium adherence, and 24.41% low adherence to the treatment. Lipid-lowering drugs were prescribed to 46.39% of the patients, all of whom were treated with statins. Among this group, 34.44% reported high adherence, 27.78% medium adherence, and 37.78% low adherence to pharmacotherapy. According to the ACDS, the majority of patients (45.55%) received a score indicating medium adherence (21–26 points), 39.27% high adherence ( > 26 points), and 16.75% low adherence to treatment ( < 21 points). A high level of adherence was declared by 61.54% of the patients that reached the therapeutic goal of lipid-lowering therapy, defined as LDL-C of < 2.6 mmol/L ( < 100 mg/dL). On the other hand, among the patients whose LDL-C remained elevated, 23.44% declared high adherence to treatment. There were no significant differences in achieving the intended therapeutic goal of blood pressure (BP ≤ 140/90 mmHg) in the groups with high, medium and low adherence (26.53% vs. 23.47% vs. 50.00%; p = 0.1880).
Conclusion: Despite higher adherence to treatment in the patients with hypertension compared to patients with hyperlipidemia, the latter more often achieved the therapeutic goal. Declarations regarding high adherence to medication in the MAQ and in the ACDS are consistent in patients with hyperlipidemia and hypertension.
Keywords
adherence, self-report questionnaires, hyperlipidemia, hypertension
About this articleTitle
Implementation of therapeutic recommendations in high cardiovascular-risk patients. The Polish population of EUROASPIRE V survey
Journal
Issue
Article type
Original article
Pages
230-236
Published online
2021-09-22
Page views
6090
Article views/downloads
524
DOI
Bibliographic record
Medical Research Journal 2021;6(3):230-236.
Keywords
adherence
self-report questionnaires
hyperlipidemia
hypertension
Authors
Ewa Laskowska
Piotr Michalski
Łukasz Pietrzykowski
Michał Kasprzak
Agata Kosobucka
Klaudyna Grzelakowska
Krzysztof Buczkowski
Piotr Jankowski
Zbigniew Gąsior
Dariusz Kosior
Karol Kamiński
Aldona Kubica
References (41)- Bosworth HB, Granger BB, Mendys P, et al. Medication adherence: a call for action. Am Heart J. 2011; 162(3): 412–424.
- Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011; 86(4): 304–314.
- Pietrzykowski Ł, Michalski P, Kosobucka A, et al. Medication adherence and its determinants in patients after myocardial infarction. Sci Rep. 2020; 10(1): 12028.
- Simpson SH, Eurich DT, Majumdar SR, et al. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ. 2006; 333(7557): 15.
- Kubica J, Adamski P, Buszko K, et al. Rationale and design of the effectiveness of lower maintenanCe dose of TicagRelor early after myocardial infarction (ELECTRA) pilot study. Eur Heart J Cardiovasc Pharmacother. 2018; 4(3): 152–157.
- DiMatteo MR. Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004; 42(3): 200–209.
- Tang L, Patao C, Chuang J, et al. Cardiovascular risk factor control and adherence to recommended lifestyle and medical therapies in persons with coronary heart disease (from the National Health and Nutrition Examination Survey 2007-2010). Am J Cardiol. 2013; 112(8): 1126–1132.
- Lam WY, Fresco P. Medication adherence measures: an overview. Biomed Res Int. 2015; 2015: 217047.
- Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021; 42(34): 3227–3337.
- 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): 2940–2948.
- De Bacquer D, Astin F, Kotseva K, et al. EUROASPIRE IV and V surveys of the European Observational Research Programme of the European Society of Cardiology. Poor adherence to lifestyle recommendations in patients with coronary heart disease: results from the EUROASPIRE surveys. Eur J Prev Cardiol. 2021 [Epub ahead of print].
- Naderi SH, Bestwick JP, Wald DS. Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376,162 patients. Am J Med. 2012; 125(9): 882–887.e1.
- Kubica A, Kasprzak M, Obońska K, et al. Discrepancies in assessment of adherence to antiplatelet treatment after myocardial infarction. Pharmacology. 2015; 95(1-2): 50–58.
- Buszko K, Obońska K, Michalski P, et al. The Adherence Scale in Chronic Diseases (ASCD). The power of knowledge: the key to successful patient — health care provider cooperation. Med Res J. 2016; 1(1): 37–42.
- Kubica A, Kosobucka A, Michalski P, et al. The Adherence in Chronic Diseases Scale — a new tool to monitor implementation of a treatment plan. Folia Cardiol. 2017; 12: 19–26.
- Hill M, Miller N, DeGeest S. Adherence and persistence with taking medication to control high blood pressure. J Am Soc Hypertens. 2011; 5(1): 56–63.
- Burnier M, Egan BM. Adherence in hypertension. Circ Res. 2019; 124(7): 1124–1140.
- Ho PM, Lambert-Kerzner A, Carey EP, et al. Multifaceted intervention to improve medication adherence and secondary prevention measures after acute coronary syndrome hospital discharge: a randomized clinical trial. JAMA Intern Med. 2014; 174(2): 186–193.
- Bansilal S, Castellano JM, Garrido E, et al. Assessing the impact of medication adherence on long-term cardiovascular outcomes. J Am Coll Cardiol. 2016; 68(8): 789–801.
- Vrijens B, Vincze G, Kristanto P, et al. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ. 2008; 336(7653): 1114–1117.
- Kubica A, Kasprzak M, Obońska K, et al. Impact of health education on adherence to clopidogrel and clinical effectiveness of antiplatelet treatment in patients after myocardial infarction. Med Res J. 2015; 3(4): 154–159.
- Michalski P, Kasprzak M, Siedlaczek M, et al. The impact of knowledge and effectiveness of educational intervention on readiness for hospital discharge and adherence to therapeutic recommendations in patients with acute coronary syndrome. Med Res J. 2020; 5(2): 72–78.
- Fischer MA, Choudhry NK, Brill G, et al. Trouble getting started: predictors of primary medication nonadherence. Am J Med. 2011; 124(11): 1081.e9–1081.e22.
- Pietrzykowski Ł, Kasprzak M, Michalski P, et al. Therapy discontinuation after myocardial infarction. J Clin Med. 2020; 9(12): 4109.
- Kubica A, Pietrzykowski Ł. The therapeutic plan implementation in patients discharged from the hospital after myocardial infarction. Med Res J. 2021; 6(2): 79–82.
- Kosobucka A, Pietrzykowski Ł, Michalski P, et al. Impact of readiness for discharge from the hospital on the implementation of the therapeutic plan. Med Res J. 2020; 5(4): 256–264.
- Visseren FLJ, Mach F, Smulders YM, et al. ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021; 42(34): 3227–3337.
- Reiner Ž, De Backer G, Fras Z, et al. EUROASPIRE Investigators. Lipid lowering drug therapy in patients with coronary heart disease from 24 European countries — findings from the EUROASPIRE IV survey. Atherosclerosis. 2016; 246: 243–250.
- Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation. 2009; 119(23): 3028–3035.
- Kubica A, Adamski P, Bączkowska A, et al. The rationale for Multilevel Educational and Motivational Intervention in Patients after Myocardial Infarction (MEDMOTION) project is to support multicentre randomized clinical trial Evaluating Safety and Efficacy of Two Ticagrelor-based De-escalation Antiplatelet Strategies in Acute Coronary Syndrome (ELECTRA – SIRIO 2). Med Res J. 2020; 5(4): 244–249.
- Kubica A, Obońska K, Fabiszak T, et al. Adherence to antiplatelet treatment with P2Y12 receptor inhibitors. Is there anything we can do to improve it? A systematic review of randomized trials. Curr Med Res Opin. 2016; 32(8): 1441–1451.
- Kubica A, Obońska K, Kasprzak M, et al. Prediction of high risk of non-adherence to antiplatelet treatment. Kardiol Pol. 2016; 74(1): 61–67.
- Kubica A, Kochman W, Bogdan M, et al. The influence of undergone percutaneous coronary interventions, and earlier hospitalizations with myocardial infarction on the level of knowledge and the effectiveness of health education in patients with myocardial infarction. Advances in Interventional Cardiology. 2009; 5(1): 25–30.
- Kubica A, Kasprzak M, Siller-Matula J, et al. Time-related changes in determinants of antiplatelet effect of clopidogrel in patients after myocardial infarction. Eur J Pharmacol. 2014; 742: 47–54.
- Kubica A, Gruchała M, Jaguszewski M, et al. Adherence to treatment — a pivotal issue in long-term treatment of patients with cardiovascular diseases. An expert standpoint. Med Res J. 2017; 2(4): 123–127.
- Kubica A. Self-reported questionnaires for a comprehensive assessment of patients after acute coronary syndrome. Med Res J. 2019; 4(2): 106–109.
- Kubica A, Kosobucka A, Michalski P, et al. Self-reported questionnaires for assessment adherence to treatment in patients with cardiovascular diseases. Med Res J. 2018; 2(4): 115–122.
- Kosobucka A, Michalski P, Pietrzykowski Ł, et al. Adherence to treatment assessed with the Adherence in Chronic Diseases Scale in patients after myocardial infarction. Patient Prefer Adherence. 2018; 12: 333–340.
- Pietrzykowski Ł, Kasprzak M, Michalski P, et al. The influence of patient expectations on adherence to treatment regimen after myocardial infarction. Patient Educ Couns. 2021 [Epub ahead of print].
- McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA. 2002; 288(22): 2868–2879.
- Roumie CL, Greevy R, Wallston KA, et al. Patient centered primary care is associated with patient hypertension medication adherence. J Behav Med. 2011; 34(4): 244–253.